Active NPI
Benjamin Jonah Statman
- Dental Anesthesiology
- Columbus, OH
National Provider Identifier
1093289647
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Anesthesiology
- License
- 30.026729
- Practice address
- 1103 Schrock Rd Ste 201
Columbus, OH 43229-1179 - Phone
- (614) 401-4415
- NPI assigned
- Jan 16, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Anesthesiology | 1223D0004X | 30.026729 | OH | Primary |
| Dentist | 122300000X | 30.026729 | OH | |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
1103 Schrock Rd Ste 201
Columbus, OH 43229-1179
Mailing address
4486 Baintree Rd
University Heights, OH 44118-3933
Phone (818) 618-3663
Other practice location 1
151 Westchester Hall
Stony Brook, NY 11794-0001
Phone (631) 444-2557
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30.026729 | OH | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Offor Med, Inc. | Past | Accepting new patients | |
| Offor Health, Inc | Dental Anesthesiology | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Anesthesiology Physician
- Worthington, OH
- NPI 1396317285
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1547596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656633600000",
"number": "1093289647",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4486 BAINTREE RD",
"city": "UNIVERSITY HEIGHTS",
"state": "OH",
"postal_code": "441183933",
"telephone_number": "818-618-3663"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1103 SCHROCK RD STE 201",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432291179",
"telephone_number": "614-401-4415"
}
],
"practiceLocations": [
{
"address_1": "151 Westchester Hall",
"address_purpose": "LOCATION",
"city": "Stony Brook",
"state": "NY",
"postal_code": "117940001",
"country_code": "US",
"telephone_number": "631-444-2557",
"fax_number": "631-444-6013",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "STATMAN",
"first_name": "BENJAMIN",
"middle_name": "JONAH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-01-16",
"last_updated": "2022-07-01",
"certification_date": "2022-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "1223D0004X",
"taxonomy_group": "",
"desc": "Dentist, Dental Anesthesiology",
"state": "OH",
"license": "30.026729",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OH",
"license": "30.026729",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbus, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.