KELLY BLACK PMHNP-BC
NPI 1912653536
Nurse Practitioner - Psychiatric/Mental Health in Mesa, AZ
About Kelly Black Pmhnp-bc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KELLY BLACK PMHNP-BC (NPI 1912653536) is an individual psychiatric/mental health provider in Mesa, Arizona, licensed in California (95024873) and active in the NPI registry since February 2022. She is enrolled in Medicare PECOS and maintains a secondary practice location in Homeland.
NPPES Registry Identity
Specialties & Licenses 2
Secondary Practice Location 1
Other Identifiers 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Kelly Black Pmhnp-bc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Kelly Black reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Mesa, AZ 85204
- Reassigned Medicare billing, Arizona enrollment
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 85204 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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.
MESA, AZ 85204
MESA, AZ 85204
MESA, AZ 85204
MESA, AZ 85204
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 1912653536. It was assigned to this individual provider in the NPPES registry on February 22, 2022.
Where is Kelly Black located?
Kelly Black practices at 1910 S Stapley Dr Ste 120, Mesa, AZ 85204. The listed phone number is (602) 341-3303.
What is Kelly Black's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.
Is Kelly Black enrolled in Medicare?
Yes. Kelly Black is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Kelly Black's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kelly Black reassigns Medicare benefits to Ahp Psych Np PC (Mesa, AZ). 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 Kelly Black's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Kelly Black accept?
Health plans from Cigna HealthCare of Arizona, Inc and UnitedHealthcare 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 February 6, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months 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.
# Kelly Black, PMHNP-BC · NPI 1912653536
Psychiatric/Mental Health physician in Mesa, Arizona. Individual provider, active in the CMS NPPES registry since February 22, 2022.
## Identity
- **NPI:** 1912653536 (Entity type: Individual)
- **Enumerated:** February 22, 2022
- **Primary specialty:** Nurse Practitioner - Psychiatric/Mental Health · taxonomy 363LP0808X
- **State license:** 95024873 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 1910 S STAPLEY DR STE 120, Mesa, AZ 85204-6676
- **Phone:** (602) 341-3303
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Ahp Psych Np PC (NPI 1649094012, Mesa, AZ), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** February 6, 2025
- **Other identifiers:** Other 305924 (AZ)
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Source: [NPI Profile](https://npiprofile.com/npi/1912653536) · Data from the CMS NPPES public registry.