NPIMap

Organization Active NPI

Blue Diamond Family Dental SC

  • Dentist
  • Bloomer, WI
National Provider Identifier
1245433580
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
BLUE DIAMOND FAMILY DENTAL SC
Practice address
1502 Main St
Bloomer, WI 54724-1686
Phone
(715) 568-2363
Fax
(715) 568-2373
NPI assigned
Jun 6, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Connie C Parr
Title
Business Manager
Phone
(715) 568-2363

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X Primary

Addresses

Primary practice location

1502 Main St
Bloomer, WI 54724-1686

Mailing address

1502 Main St
Bloomer, WI 54724-1686
Phone (715) 568-2363

Other identifiers 1

IdentifierTypeStateIssuer
38390300MedicaidWI

National Provider Directory

National Provider Directory

Locations

1502 Main St
Bloomer, WI 54724
Phone (715) 568-2363

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1181088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1245433580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1502 MAIN ST",
            "city": "BLOOMER",
            "state": "WI",
            "postal_code": "547241686",
            "telephone_number": "715-568-2363",
            "fax_number": "715-568-2373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1502 MAIN ST",
            "city": "BLOOMER",
            "state": "WI",
            "postal_code": "547241686",
            "telephone_number": "715-568-2363",
            "fax_number": "715-568-2373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE DIAMOND FAMILY DENTAL SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PARR",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "715-568-2363",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38390300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomer, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.