DR. SAMANTHA MONIQUE BLACK (MD) – Dermatology Physician, NPI 1891375465
Dermatology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,284 DERMATOLOGY in TX
Provider Addresses for DR. SAMANTHA MONIQUE BLACK (MD)
7300 RANCH ROAD 2222, BLDG 1, STE 200
AUSTIN, TX 787303255
Phone: (512) 628-0465
Fax: (512) 233-2711
Type: Mailing
1615 HOSPITAL PKWY STE 306
BEDFORD, TX 760225936
Phone: (817) 684-5100
Fax: (817) 684-5101
Type: Location
1500 S MAIN ST # S
FORT WORTH, TX 761044917
Phone: (817) 702-1244
Type: Mailing
1500 S MAIN ST
FORT WORTH, TX 761044917
Phone: (817) 702-1244
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2025-04-17
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20250417000366 | I | Dermatology | TX | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 78730)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | TX | |
| D E R M A T O L O G Y | TX | |
| Physician Assistant | TX | |
| D E R M A T O L O G Y | TX | |
| Interventional Radiology, Diagnostic Radiology | TX | |
| D E R M A T O L O G Y | TX | |
| D E R M A T O L O G Y | TX | |
| D E R M A T O L O G Y | TX | |
| D E R M A T O L O G Y | TX | |
| Physician Assistant | AZ |
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