Randall David Stastny, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

30-1-8892 Issued in OH

Practice address

4350 Malsbary Rd
Suite 201
Blue Ash, OH 45242-5665

Phone

(513) 984-2100

Fax

(513) 984-2155

NPI assigned

Jul 7, 2005

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

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

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 1, 2015 through Apr 1, 2027

Medicare enrollment (NPD)

Enrolled

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.

• Cincinnati Oral & Maxillofacial Surgery Assoc., Inc.

  • Oral and Maxillofacial Surgery (Dentist)
  • Cincinnati, OH
  • NPI 1861685968
  NPD (past)
• Cincinnati Oral &Maxillofacial Surgery Assoc.,Inc.

  • Oral and Maxillofacial Surgery (Dentist)
  • Cincinnati, OH
  • NPI 1215120324
  NPD (past)
• University Surgical-Dental Associates, LLC

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Cincinnati, OH
  • NPI 1649241787

  Oral and Maxillofacial Surgery

  NPD (past)

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331856000000",
    "number": "1699772509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4350 MALSBARY RD",
            "address_2": "SUITE 201",
            "city": "BLUE ASH",
            "state": "OH",
            "postal_code": "452425665",
            "telephone_number": "513-984-2100",
            "fax_number": "513-984-2155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4350 MALSBARY RD",
            "address_2": "SUITE 201",
            "city": "BLUE ASH",
            "state": "OH",
            "postal_code": "452425665",
            "telephone_number": "513-984-2100",
            "fax_number": "513-984-2155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STASTNY",
        "first_name": "RANDALL",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2012-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OH",
            "license": "30-1-8892",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "11892",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sondra Stallworth
• Jeffrey C Standley, M.D.
• Eliza Stanford, OTR/L
• Kaitlyn A. Stanforth, LPCC
• Christopher Phillip Starks
• Geneva Statts, SW-T
• Chelsea Lynne Staubach, RN
• Rachel Christina Steele, M.A., CF-SLP
• Frances Steiner
• Jessica Leann Steinhauer

• Oral and Maxillofacial Surgery (Dentist) in Blue Ash, OH
• Providers in Blue Ash, OH by specialty
• Oral and Maxillofacial Surgery (Dentist) in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2012; 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.

Verify at the official NPI Registry.