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DR. KELLY DAWN BLACK MD, MSC
NPI 1457499592
Emergency Medicine - Pediatric Emergency Medicine in Fort Worth, TX

Active since February 01, 2007PECOS Enrolled
801 7TH AVE, FORT WORTH, TX 76104(682) 885-4095(682) 885-7499 Get Directions Write a Review

NPPES record last updated: April 28, 2021. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Apr 28, 2021, Apr 9, 2021, Oct 1, 2015 (3 updates tracked since 2015).

About Dr. Kelly Dawn Black Md, Msc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KELLY DAWN BLACK MD, MSC (NPI 1457499592) is an individual pediatric emergency medicine provider in Fort Worth, Texas, licensed in South Dakota (8697) and active in the NPI registry since February 2007. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1457499592
Entity TypeIndividualFemale
Primary Taxonomy207PP0204X
Provider Legal NameDR. KELLY DAWN BLACKCredential: MD, MSC
Location Address801 7TH AVEFort Worth, TX 76104-2733
Mailing AddressPo Box 733784Dallas, TX 75373-3784 · (682) 885-1855 · Fax (682) 885-1396
Phone(682) 885-4095
Fax(682) 885-7499
Sole ProprietorNo
Enumeration DateFebruary 1, 2007
Last NPPES UpdateApril 28, 20213 updates tracked since enumeration
NPPES CertifiedApril 28, 2021
✔ NPI 1457499592 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyEmergency Medicine · Pediatric Emergency MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207PP0204X
License✔ Licensed in SD · 8697
Definition
Pediatric Emergency Medicine is a clinical subspecialty that focuses on the care of the acutely ill or injured child in the setting of an emergency department.
Also ListedPediatrics · Pediatric Emergency MedicineTaxonomy 2080P0204X · License MD 6047537 (WA), 41081 (KY)
801 7TH AVE, Fort Worth, TX 76104
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Baylor Scott and White Health Plan, Medica.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Kelly Dawn Black Md, Msc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 76104 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$87.20 typical visit price
range $56.47 – $171.07
Typical copayment $21.80 (range $14.11 – $42.76)
Most-billed visit code 99203
Established Patient
$99.68 typical visit price
range $18.18 – $139.68
Typical copayment $24.92 (range $4.54 – $34.92)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

RACHEL MARIE SOUERS M.D.
Pediatrics
801 7TH AVE
FORT WORTH, TX 76104
Tarrant County (682) 885-6726
JAMIE L COLE LCSW
Social Worker (Clinical)
801 7TH AVE, CASE MANAGEMENT
FORT WORTH, TX 76104
Tarrant County (682) 885-3991
ANNE MARCUM KIRK M.D.
Hospitalist
801 7TH AVE
FORT WORTH, TX 76104
Tarrant County (682) 885-1475
KRISTI E TUCKER FNP
Nurse Practitioner (Family)
801 7TH AVE
FORT WORTH, TX 76104
Tarrant County (682) 885-1475
ISAAC WILSON RN
Registered Nurse
801 7TH AVE
FORT WORTH, TX 76104
Tarrant County (682) 885-4000
DR. BRITTON MICHAEL DEVILLIER M.D., M.P.H.
Emergency Medicine (Pediatric Emergency Medicine)
801 7TH AVE
FORT WORTH, TX 76104
Tarrant County (682) 885-4095
DR. PHUONG THI NGUYEN M.D.
Hospitalist
801 7TH AVE
FORT WORTH, TX 76104
Tarrant County (682) 885-1475
DR. MIRIAM ALLISON BLUM DO
Hospitalist
801 7TH AVE
FORT WORTH, TX 76104
Tarrant County (682) 885-1475

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Black's NPI number?

The NPI number for Kelly Black is 1457499592. It was assigned to this individual provider in the NPPES registry on February 1, 2007.

Where is Kelly Black located?

Kelly Black practices at 801 7th Ave, Fort Worth, TX 76104. The listed phone number is (682) 885-4095.

What is Kelly Black's specialty?

The primary specialty registered for this NPI is Emergency Medicine, specializing in Pediatric Emergency Medicine, with taxonomy code 207PP0204X.

Is Kelly Black enrolled in Medicare?

Yes. Kelly Black is registered in the Medicare PECOS enrollment system.

What insurance does Kelly Black accept?

Health plans from Baylor Scott and White Health Plan and Medica list Kelly Black as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kelly Black was last updated on April 28, 2021. NPI Profile syncs with the weekly NPPES data releases published by CMS.