Robert Harris Range, D.D.S

Primary specialty

DentistTaxonomy code 122300000X

License

059481 Issued in NY

Practice address

US Army Fort Drum Stone Dental Clinic
10590 Enduring Freedom Drive
Apo, AA 13602

Phone

(315) 772-5576

NPI assigned

Jul 11, 2012

Last updated

Jul 13, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: robert.range.1@21901.direct.athenahealth.com

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.

• Guthrie Ahc

  dba Usadc Stone-Drum

  • Military/U.S. Coast Guard Outpatient Clinic/Center
  • Fort Drum, NY
  • NPI 1740486091
  NPD (past)
• North Country Family Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Lowville, NY
  • NPI 1235928177
  NPD (past)
• North Country Family Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Watertown, NY
  • NPI 1609946821
  NPD (past)

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

{
    "created_epoch": "1341964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657670400000",
    "number": "1144585605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "MIL",
            "address_1": "US ARMY FORT DRUM STONE DENTAL CLINIC",
            "address_2": "10590 ENDURING FREEDOM DRIVE",
            "city": "APO",
            "state": "AA",
            "postal_code": "13602",
            "telephone_number": "315-772-5576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "MIL",
            "address_1": "US ARMY FORT DRUM STONE DENTAL CLINIC",
            "address_2": "10590 ENDURING FREEDOM DRIVE",
            "city": "APO",
            "state": "AA",
            "postal_code": "13602",
            "telephone_number": "315-772-5576"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1261 8th Ave Apt 101",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941222446",
            "country_code": "US",
            "telephone_number": "504-289-8953",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RANGE",
        "first_name": "ROBERT",
        "middle_name": "HARRIS",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-11",
        "last_updated": "2022-07-13",
        "certification_date": "2022-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "059481",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "62737",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.