Joshua Leon Blimbaum, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DN21484 Issued in FL

Practice address

12058 San Jose Blvd Ste 102
Jacksonville, FL 32223-8669

Phone

(904) 880-3131

NPI assigned

Oct 29, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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.

• Jacksonville Dentistry PLLC

  • Dental Clinic/Center
  • Jacksonville, FL
  • NPI 1417541079
  NPD (past)
• Krantz Dental Care, P.a.

  • General Practice Dentistry
  • Jacksonville, FL
  • NPI 1922288364
  NPD (past)

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

{
    "created_epoch": "1446076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539820800000",
    "number": "1912379926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12058 SAN JOSE BLVD STE 102",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322238669",
            "telephone_number": "954-802-8061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12058 SAN JOSE BLVD STE 102",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322238669",
            "telephone_number": "904-880-3131"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "The Carlson Group",
            "address_2": "13241 Bartram Park Blvd #1700",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "32258",
            "country_code": "US",
            "telephone_number": "904-262-8409",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLIMBAUM",
        "first_name": "JOSHUA",
        "middle_name": "LEON",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-10-29",
        "last_updated": "2018-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN21484",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D009321",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN21484",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blessed Assisted Living Home, LLC
• Blessedful Breastfeeding LLC
• Danielle Blevins
• Nicole Blevins
• Michael Alan Bliemeister, RPH
• Frederick J. Blind, MD
• Alexandra Blinder, MSW
• Elyssa Blissenbach, MD PA
• Blithe Solutions LLC
• Lisa S. Blizzard, SUPPORT COORDINATOR

• Dentist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2018; 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.