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THOMAS BLACK NP
NPI 1619346376
Nurse Practitioner - Family in Edgewood, NM

Active since September 23, 2015PECOS Enrolled
104 QUAIL TRAIL, UNIT B, EDGEWOOD, NM 87015(505) 208-0208(505) 717-2884 Get Directions Write a Review

NPPES record last updated: July 26, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jul 26, 2021, Jul 21, 2021, Jun 30, 2016 (3 updates tracked since 2016).

About Thomas Black Np NPPES

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

THOMAS BLACK NP (NPI 1619346376) is an individual family provider in Edgewood, New Mexico, licensed in New Mexico (02922) and active in the NPI registry since September 2015. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1619346376
Entity TypeIndividualMale
Primary Taxonomy363LF0000X
Provider Legal NameTHOMAS BLACKCredential: NP
Location Address104 QUAIL TRAIL, UNIT BEdgewood, NM 87015
Mailing Address104 Quail Trail, Unit BEdgewood, NM 87015 · (505) 208-0204 · Fax (505) 717-2884
Phone(505) 208-0208
Fax(505) 717-2884
Sole ProprietorNo
Enumeration DateSeptember 23, 2015
Last NPPES UpdateJuly 26, 20213 updates tracked since enumeration
NPPES CertifiedJuly 26, 2021
✔ NPI 1619346376 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in NM · 02922
104 QUAIL TRAIL, Edgewood, NM 87015
Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Texas.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Thomas Black Np 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.

Medicare Billing Reassignment

Medicare enrollment records show Thomas Black reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Dhhs Phs Naihs Crownpoint Hospital
119 mi
General Acute Care Hospital
JUNCTION OF HWY 371, NAVAJO RT9
Crownpoint, NM 87313
  • Reassigned Medicare billing, Texas enrollment
  • 265 clinicians in this Medicare group
NPI 1114960093 (505) 786-5291

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 87015 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
$84.79 typical visit price
range $54.26 – $166.80
Typical copayment $21.19 (range $13.56 – $41.70)
Most-billed visit code 99203
Established Patient
$96.38 typical visit price
range $17.00 – $135.35
Typical copayment $24.09 (range $4.25 – $33.83)
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 4

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

THU THANH NGUYEN FNP
Nurse Practitioner (Family)
104 QUAIL TRAIL, UNIT B
EDGEWOOD, NM 87015
Santa Fe County (505) 208-0204
SERINA JOHNSON
Licensed Practical Nurse
104 QUAIL TRAIL, UNIT B
EDGEWOOD, NM 87015
Santa Fe County (505) 208-0204
MRS. KALEIGH ROBERTS FNP
Nurse Practitioner (Family)
104 QUAIL TRAIL, UNIT B
EDGEWOOD, NM 87015
Santa Fe County (505) 208-0204
DOUGLAS IVAN LUDINGTON NP
Nurse Practitioner (Family)
104 QUAIL TRAIL, UNIT B
EDGEWOOD, NM 87015
Santa Fe County (505) 208-0204

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 Thomas Black's NPI number?

The NPI number for Thomas Black is 1619346376. It was assigned to this individual provider in the NPPES registry on September 23, 2015.

Where is Thomas Black located?

Thomas Black practices at 104 Quail Trail Unit B, Edgewood, NM 87015. The listed phone number is (505) 208-0208.

What is Thomas Black's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Thomas Black enrolled in Medicare?

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

Which organization bills Medicare for Thomas Black's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Thomas Black reassigns Medicare benefits to Dhhs Phs Naihs Crownpoint Hospital (Crownpoint, NM). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Thomas Black's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Thomas Black accept?

Health plans from Blue Cross and Blue Shield of Texas list Thomas 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 Thomas Black was last updated on July 26, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.