| Charles Thomas Black, MD | |
|
12200 Park Central Dr Ste 400, Dallas, TX 75251-2116 | |
| (214) 483-9300 | |
| (214) 483-9301 |
| Full Name | Charles Thomas Black |
|---|---|
| Gender | Male |
| Speciality | Surgery - Pediatric Surgery |
| Location | 12200 Park Central Dr Ste 400, Dallas, Texas |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528049723 | NPI | - | NPPES |
| 4130343 | Other | TX | AETNA |
| 138311911 | Medicaid | TX | |
| 389962 | Other | TX | ONE HEALTH PLAN |
| 127631 | Other | TX | SUPERIOR CHIP |
| 80390N | Other | BLUE CROSS | |
| 153410004 | Other | TX | PACIFICARE |
| 3725428015 | Other | TX | CIGNA |
| 138311914 | Other | TX | CSHCN |
| 41814 | Other | TX | AETNA MEDICAID |
| 0134405 | Other | TX | UNITED HEALTH CARE |
| 10009560 | Other | TX | AMERIGROUP |
| 138311913 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2086S0120X | Surgery - Pediatric Surgery | F3761 (Texas) | Primary |
| Entity Name | Magella Medical Associates Billing Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1083631071 PECOS PAC ID: 8729970215 Enrollment ID: O20041115001144 |
| Mailing Address | Practice Location Address |
|---|---|
| Charles Thomas Black, MD 12200 Park Central Dr Ste 400, Dallas, TX 75251-2116 Ph: (214) 483-9300 | Charles Thomas Black, MD 12200 Park Central Dr Ste 400, Dallas, TX 75251-2116 Ph: (214) 483-9300 |
Cassidy Ann Gafford, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 8210 Walnut Hill Ln Ste 505, Dallas, TX 75231 Phone: 214-345-4160 Fax: 214-345-4165 | |
Brett D Arnoldo, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 5323 Harry Hines Blvd, Dallas, TX 75390 Phone: 214-648-3067 | |
Dr. Gail S Lebovic, MD Surgery Medicare: Not Enrolled in Medicare Practice Location: 12200 Preston Rd, Dallas, TX 75230 Phone: 972-560-2667 | |
Dr. Russell C Lam, M.D. Surgery Medicare: Accepting Medicare Assignments Practice Location: 8210 Walnut Hill Ln Ste 505, Dallas, TX 75231 Phone: 214-345-4160 Fax: 214-345-4165 | |
Dr. Brian Ezekian, M.D. Surgery Medicare: Medicare Enrolled Practice Location: 7777 Forest Ln Ste C240, Dallas, TX 75230 Phone: 972-566-7000 | |
Nirmal Samuel Jayaseelan, M.D. Surgery Medicare: May Accept Medicare Assignments Practice Location: 11970 N Central Expy Ste 670, Dallas, TX 75243 Phone: 972-331-1111 Fax: 972-331-1112 | |
Dr. Mirza Shadman Baig, M.D. Surgery Medicare: Accepting Medicare Assignments Practice Location: 2001 Inwood Rd, 5th Fl, West Campus Bldg 3, Dallas, TX 75390 Phone: 214-645-0538 Fax: 214-645-0536 |