Leonicia Raschel Blue, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

30-022848 Issued in OH

Practice address

6725 W Central Ave Ste M111
Toledo, OH 43617-1148

Phone

(623) 434-9343

NPI assigned

Oct 7, 2008

Sex

Female

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 VA

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

Specialty

Dentist

Education

Other, 2007

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Johnson Health Center

  • Federally Qualified Health Center (FQHC)
  • Lynchburg, VA
  • NPI 1316926538
  Medicare reassignment NPD
• Johnson Health Center

  • Federally Qualified Health Center (FQHC)
  • Lynchburg, VA
  • NPI 1821212481
  Medicare reassignment NPD
• Johnson Health Center

  • Federally Qualified Health Center (FQHC)
  • Madison Heights, VA
  • NPI 1972858660
  NPD
• Ocean Dental of Ohio, P.C.

  • General Practice Dentistry
  • Cleveland, OH
  • NPI 1629292826
  NPD (past)

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

{
    "created_epoch": "1223337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703116800000",
    "number": "1952552002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2501 CHATHAM RD STE 4031",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627044188",
            "telephone_number": "234-400-9199",
            "fax_number": "216-229-2501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6725 W CENTRAL AVE STE M111",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436171148",
            "telephone_number": "623-434-9343"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2501 Chatham Rd Ste 4031",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "IL",
            "postal_code": "627044188",
            "country_code": "US",
            "telephone_number": "234-400-9199",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLUE",
        "first_name": "LEONICIA",
        "middle_name": "RASCHEL",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-07",
        "last_updated": "2023-12-21",
        "certification_date": "2023-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "24502",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30-022848",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401418036",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Michelle Blue, MSW, LISW-S
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• Benjamin Bluitt, LCDCII

• General Practice Dentistry in Toledo, OH
• Providers in Toledo, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.