Dr Kelly Dawn Black, MD, MSC - Medicare Emergency Medicine 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 NameDr Kelly Dawn Black
GenderFemale
SpecialityEmergency Medicine - Pediatric Emergency Medicine
Location801 7th Ave, Fort Worth, Texas
Accepts Medicare AssignmentsMedicare 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.
IdentifierTypeStateIssuer
1457499592NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
2080P0204XPediatrics - Pediatric Emergency Medicine 41081 (Kentucky)Secondary
2080P0204XPediatrics - Pediatric Emergency Medicine MD 6047537 (Washington)Secondary
207PP0204XEmergency 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 NameCook Childrens Physician Network
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI 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 AddressPractice 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    

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

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