Kelly Renee Black

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

430 Morton Plant St Ste 301
Clearwater, FL 33756-3395

Phone

(813) 978-9700

NPI assigned

Sep 8, 2017

Last updated

May 18, 2026By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Synergic Healthcare Solutions LLCGroup PAC ID 7618235573, 94 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://epicproxy.et0761.epichosted.com/FHIRProxy/api/FHIR/R4/
• Direct secure messaging: kblack313874@direct.tgh.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Synergic Healthcare Solutions LLC

  dba Fast Track Urgent Care Center

  • Urgent Care Clinic/Center
  • Tampa, FL
  • NPI 1063718013
  Medicare reassignment Care Compare group
• Musculoskeletal Institute Chartered

  dba Florida Orthopaedic Institute

  • Orthopaedic Surgery Physician
  • Temple Terrace, FL
  • NPI 1386639920

  Single Specialty

  Medicare reassignment NPD
• Musculoskeletal Institute Chartered

  • Orthopaedic Surgery Physician
  • Zephyrhills, FL
  • NPI 1467305839
  NPD
• Synergic Healthcare Solutions LLC

  dba Fast Track Urgent Care Center

  • Urgent Care Clinic/Center
  • Riverview, FL
  • NPI 1003366402
  NPD
• Synergic Healthcare Solutions LLC

  • Urgent Care Clinic/Center
  • Punta Gorda, FL
  • NPI 1174336119
  NPD
• Synergic Healthcare Solutions LLC

  dba Fast Track Urgent Care Center

  • General Practice Physician
  • Wesley Chapel, FL
  • NPI 1194198382

  Single Specialty

  NPD
• Tampa General Hospital

  • General Acute Care Hospital
  • Tampa, FL
  • NPI 1124558929
  NPD
• Tallahassee Orthopedic Clinic III PL

  dba Tallahassee Orthopedic Clinic

  • Medical Specialty Clinic/Center
  • Tallahassee, FL
  • NPI 1194778050

  Single Specialty

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1504828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779062400000",
    "number": "1508384736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13020 N TELECOM PKWY",
            "city": "TEMPLE TERRACE",
            "state": "FL",
            "postal_code": "336370915",
            "telephone_number": "813-978-9700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 MORTON PLANT ST STE 301",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337563395",
            "telephone_number": "813-978-9700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3301 W Gandy Blvd",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "336112931",
            "country_code": "US",
            "telephone_number": "813-925-1903",
            "fax_number": "813-749-8370",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACK",
        "first_name": "KELLY",
        "middle_name": "RENEE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-09-08",
        "last_updated": "2026-05-18",
        "certification_date": "2026-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "PA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "116670800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Beverly Jane Bitterman, ARNP
• Joseph Patrick Bivona, PA-C
• BJ's Wholesale Club Inc.
• Amina Brandy Black, CRNA, MSN
• Karen Ruth Black, B.A.
• Lois Black, RN LMT
• Melissa Black
• Emmett Andrew Blahnik, DC
• Lakeisha Joyce Blair-Watson, M.D.
• Jayla Nicole Blair

• Physician Assistant in Clearwater, FL
• Providers in Clearwater, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.