Randolph F Blakeman, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

041658-1 Issued in NY

Practice address

184 Saratoga Rd
Glenville, NY 12302-4515

Phone

(518) 399-9450

Fax

(518) 399-9465

NPI assigned

May 7, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

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.

• Fraser Fraser Dental PLLC

  • Dental Clinic/Center
  • Glenville, NY
  • NPI 1063365146
  NPD (past)

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464048000000",
    "number": "1245442573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "184 SARATOGA RD",
            "city": "GLENVILLE",
            "state": "NY",
            "postal_code": "123024515",
            "telephone_number": "518-399-9450",
            "fax_number": "518-399-9465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "184 SARATOGA RD",
            "city": "GLENVILLE",
            "state": "NY",
            "postal_code": "123024515",
            "telephone_number": "518-399-9450",
            "fax_number": "518-399-9465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKEMAN",
        "first_name": "RANDOLPH",
        "middle_name": "F",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-07",
        "last_updated": "2016-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "041658-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01193911",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alicia Rae Aragosa, SLP
• Kerry Archer
• Janice Gail Aronson-Hanson, OT
• Mirabelle Beck, N.P
• Amanda Belles, NP
• Karen Michelle Bodensieck, R. N.
• Christopher Stephen Boydston, LMHC
• Ellen Bressler Wakesberg, LCSW
• Sarah Brewer
• Nicole Jennifer Brooks, PHARMD,RPH

• General Practice Dentistry in Glenville, NY
• Providers in Glenville, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2016; 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.