Active NPI
James M Vlassis, DDS
- Periodontics
- Fayetteville, NY
National Provider Identifier
1417094392
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 042985-1
- Practice address
- 100 N Burdick St
Fayetteville, NY 13066-1319 - Phone
- (315) 637-0777
- Fax
- (315) 637-2337
- NPI assigned
- Jan 31, 2007
- Last updated
- Jul 29, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 042985-1 | NY | Primary |
Addresses
Primary practice location
100 N Burdick St
Fayetteville, NY 13066-1319
Mailing address
100 N Burdick St
PO Box 296
Fayetteville, NY 13066-1319
Phone (315) 637-0777
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Previously, effective Aug 18, 2016 through Aug 18, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 042985-1 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1406592000000",
"number": "1417094392",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 N BURDICK ST",
"address_2": "PO BOX 296",
"city": "FAYETTEVILLE",
"state": "NY",
"postal_code": "130661319",
"telephone_number": "315-637-0777",
"fax_number": "315-637-2337"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 N BURDICK ST",
"city": "FAYETTEVILLE",
"state": "NY",
"postal_code": "130661319",
"telephone_number": "315-637-0777",
"fax_number": "315-637-2337"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VLASSIS",
"first_name": "JAMES",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-31",
"last_updated": "2014-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "NY",
"license": "042985-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2014; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.