Dr Kelly Dawn Black, MD, MSC in Fort Worth, TX

Dr Kelly Dawn Black, MD, MSC is a medicare enrolled "Emergency Medicine - Pediatric Emergency Medicine" physician in Fort Worth, Texas. Her current practice location is 801 7th Ave, Fort Worth, Texas. You can reach out to her office (for appointments etc.) via phone at (682) 885-4095.

Dr Kelly Dawn Black is licensed to practice in South Dakota (license number 8697) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1457499592.

Contact Information

	Dr Kelly Dawn Black, MD, MSC
	801 7th Ave, Fort Worth, TX 76104-2733
	(682) 885-4095
	(682) 885-7499

Map and Direction

Physician's Profile

Full Name	Dr Kelly Dawn Black
Gender	Female
Speciality	Emergency Medicine - Pediatric Emergency Medicine
Location	801 7th Ave, Fort Worth, Texas
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1457499592
Provider Enumeration Date: 02/01/2007
Last Update Date: 04/28/2021

Medicare PECOS Information:

PECOS PAC ID: 2769572866
Enrollment ID: I20151009000244

Medical Identifiers

Medical identifiers for Dr Kelly Dawn Black such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1457499592	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
2080P0204X	Pediatrics - Pediatric Emergency Medicine	41081 (Kentucky)	Secondary
2080P0204X	Pediatrics - Pediatric Emergency Medicine	MD 6047537 (Washington)	Secondary
207PP0204X	Emergency Medicine - Pediatric Emergency Medicine	8697 (South Dakota)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Kelly Dawn Black allows following entities to bill medicare on her behalf.

Entity Name	Cook Childrens Physician Network
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1750369203 PECOS PAC ID: 7719884584 Enrollment ID: O20040128000800

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Kelly Dawn Black is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Dr Kelly Dawn Black, MD, MSC Po Box 733784, Dallas, TX 75373-3784 Ph: (682) 885-1855	Dr Kelly Dawn Black, MD, MSC 801 7th Ave, Fort Worth, TX 76104-2733 Ph: (682) 885-4095

Reviews and Comments

Emergency Medicine Doctors in Fort Worth, TX

Anna Burns Schroeder, MD Emergency Medicine Medicare: Medicare Enrolled Practice Location: 6451 Brentwood Stair Rd, Suite 202, Fort Worth, TX 76112 Phone: 713-858-4684
Joey Mayor, MD Emergency Medicine Medicare: Medicare Enrolled Practice Location: 1400 8th Ave, Fort Worth, TX 76104 Phone: 214-712-2074 Fax: 214-712-2444
Don Stewart Harper, M.D. Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 6451 Brentwood Stair Rd, Suite 200, Fort Worth, TX 76112 Phone: 817-507-1770 Fax: 817-507-1771
Dr. Britton Michael Devillier, M.D., M.P.H. Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 801 7th Ave, Fort Worth, TX 76104 Phone: 682-885-4095 Fax: 682-885-7499
Lacey A Mcdaniel, PA-C Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 7001 Granbury Rd, Fort Worth, TX 76133 Phone: 817-346-1925 Fax: 817-292-7237
Dr. Rafael Andres Raya, MD Emergency Medicine Medicare: Medicare Enrolled Practice Location: 3101 N Tarrant Pkwy, Fort Worth, TX 76177 Phone: 817-639-1000
Mr. Karim S Jamal, M.D. Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 11801 S. Freeway, Fort Worth, TX 76134 Phone: 817-293-9110

Dr Kelly Dawn Black, MD, MSC - Medicare Emergency Medicine in Fort Worth, TX