Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1528049723 Individual Practitioner Male Practitioner

Dr. Charles Thomas Black , MD

Surgery - Pediatric Surgery • Dallas, TX

Professional Overview & Biography Verified Profile Summary

Dr. Charles Black, MD is a registered healthcare professional specializing in Surgery - Pediatric Surgery in Dallas, TX. Practice services are available at 12200 PARK CENTRAL DR STE 400 under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

12200 Park Central Dr Ste 400

Dallas, TX 752512116

Telephone 2144839300
Fax 2144839301
Associated Practice Facility / Clinic
🏢 Pediatric Surgical Associates Facility NPI 1508995358

Specialty Benchmarks & Practice Insights

Comparative analytics for Surgery - Pediatric Surgery in Dallas, TX

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 17.4 Yrs
State Avg: 22.7 Yrs
Regional Practice Density
24 Specialists

Practicing in Dallas, TX (129 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2020-05-13
Surgery - Pediatric Surgery Primary Specialty

NUCC Taxonomy Code: 2086S0120X

State License TX F3761

A surgeon with expertise in the management of surgical conditions in premature and newborn infants, children and adolescents.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
138311911 (TX)
Medicaid State Provider ID
138311913 (TX)
Commercial Insurance / Payer ID Superior Chip
127631 (TX)
Commercial Insurance / Payer ID Blue Cross
80390N
Commercial Insurance / Payer ID Pacificare
153410004 (TX)
Commercial Insurance / Payer ID Aetna
4130343 (TX)
Commercial Insurance / Payer ID Cshcn
138311914 (TX)
Commercial Insurance / Payer ID Aetna Medicaid
41814 (TX)
Commercial Insurance / Payer ID United Health Care
0134405 (TX)
Commercial Insurance / Payer ID Amerigroup
10009560 (TX)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

17 Associated Practitioners
Dr. Darrell Hermann , MD

Surgery - Pediatric Surgery

NPI 1053494484

Doctor of Medicine (M.D.)

Dr. John Lanoue , MD

Surgery - Pediatric Surgery

NPI 1093809410

Doctor of Medicine (M.D.)

Dr. Jay Roden , MD

Surgery - Pediatric Surgery

NPI 1093898447

Doctor of Medicine (M.D.)

Dr. David Schindel , MD

Surgery - Pediatric Surgery

NPI 1225007727

Doctor of Medicine (M.D.)

Ansley Benson , PA

Physician Assistant

NPI 1235478645

Physician Assistant

Devyn Lane , PA-C

Physician Assistant - Surgical

NPI 1235658717

Physician Assistant (Certified)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

8 Historical Events
📍
Updated Practice Location May 13, 2020

Registered at 12200 PARK CENTRAL DR STE 400, DALLAS, TX 752512116 (Tel: 2144839300)

📍
Updated Business Mailing Address May 13, 2020

Registered at 12200 PARK CENTRAL DR STE 400, DALLAS, TX 752512116 (Tel: 2144839300)

NPI Profile Active June 17, 2010

NPI status registered as active in NPPES database

📍
Updated Practice Location June 17, 2010

Registered at 901 7TH AVE, SUITE 210, FORT WORTH, TX 761042722 (Tel: 8173367881)

📍
Updated Business Mailing Address June 17, 2010

Registered at 901 7TH AVE, SUITE 210, FORT WORTH, TX 761042722 (Tel: 8173367881)

👤
Provider Name / Credentials Updated June 17, 2010

Recorded as CHARLES BLACK, MD

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) June 17, 2010

Surgery (License #F3761 in TX)

🟢
Initial NPI Registration & Enumeration November 07, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

0 Reviews
No patient reviews submitted yet for Dr. Charles Black. Be the first to share your experience!

Sign in to leave a review for Dr. Charles Black

Only verified registered users can submit ratings, post feedback, and upload facility photos.

NPI Administrative Meta

NPI Number: 1528049723
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: November 07, 2005
Last Update: May 13, 2020
Sole Proprietor: Yes

Mailing Address

12200 Park Central Dr Ste 400

Dallas, TX 752512116

Phone: 2144839300

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.