PAUL CLIFFORD BLACK (MD) – Family Medicine Physician, NPI 1285825836
Family Medicine Physician
Main info
Doctor Profile
Contacts
Profile Insights
NPPES metrics only — not quality of care.
2,332 FAMILY PRACTICE in MO
Provider Addresses for PAUL CLIFFORD BLACK (MD)
1000 GW LN
WAYNESVILLE, MO 655832339
Phone: (573) 774-2715
Fax: (573) 202-2410
Type: Location
390 Kane St
Gate City, VA 242512753
Phone: (276) 386-3411
Fax: (276) 386-3492
Type: Location
1000 Gw Ln
Waynesville, MO 655832339
Phone: (573) 774-2715
Fax: (573) 202-2410
Type: Location
100 LANTANA RD STE 202
CROSSVILLE, TN 385551903
Phone: (931) 484-5141
Fax: (865) 374-2074
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 2 Open Payments records for all available years, with a total value of $30.
Total Amount is formed as General ($30) + Research ($0) + Ownership ($0) = $30.
Last reported payment date: 2023-12-11 • Largest payer in this snapshot: Novo Nordisk Inc ($16).
Total Amount
$30
General + Research + Ownership
Payments
2
Total payment records
General Amount
$30
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-12-11
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Novo Nordisk Inc | $16 |
| PFIZER INC. | $14 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2009-04-13
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20090126000594 | I | Family Practice | TN | TBD |
| I20090413000215 | I | Family Practice | VA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 65583)
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Provider's Procedures
Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | TN | |
| Internal Medicine | TN | |
| Nurse Practitioner | TN | |
| Nurse Practitioner | TN | |
| Internal Medicine | TN | |
| Nurse Practitioner | TN | |
| Family Practice | TN | |
| - | TN | |
| Physician Assistant | TN | |
| Nurse Practitioner | TN |
Reviews
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