Jeff Blomstedt, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DD4520 Issued in NM

Practice address

1510 E 20TH St
Suite B
Farmington, NM 87401-9033

Phone

(505) 327-6151

NPI assigned

Jun 15, 2016

Last updated

Jul 15, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NM

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Red Willow Dental, LLC

  • Dental Clinic/Center
  • McCook, NE
  • NPI 1811667421
  NPD Authorized official

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

{
    "created_epoch": "1465948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468540800000",
    "number": "1992155568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4015 ABBEY RD",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874022901",
            "telephone_number": "308-737-0684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 E 20TH ST",
            "address_2": "SUITE B",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874019033",
            "telephone_number": "505-327-6151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOMSTEDT",
        "first_name": "JEFF",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-15",
        "last_updated": "2016-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NM",
            "license": "DD4520",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ernesto Antonio Blanco, MD
• Richard Stanfill Blankenbaker Jr., MD
• Mark Bentley Bleak, DMD
• Lynne F Bliss, M.D.
• Ronald Bliss, MD
• Bloom New Mexico LLC (American Family Care)
• Samaira Bluehouse
• Bobby G Painter OD (High Desert Eye Care)
• Mary Louise Bodewes, PAC
• Carrie Boehm, RDH

• Dentist in Farmington, NM
• Providers in Farmington, NM by specialty
• Dentist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 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.