BLAINE RADLEY DDS
NPI 1902483670
Student in an Organized Health Care Education/Training Program in Jacksonville, FL
About Blaine Radley Dds NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
BLAINE RADLEY DDS (NPI 1902483670) is an individual student in an organized health care education/training program in Jacksonville, Florida and active in the NPI registry since March 2021. He is enrolled in Medicare PECOS and maintains a secondary practice location in Philadelphia.
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Blaine Radley Dds is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
JACKSONVILLE, FL 32209
JACKSONVILLE, FL 32209
JACKSONVILLE, FL 32209
JACKSONVILLE, FL 32209
JACKSONVILLE, FL 32209
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Blaine Radley's NPI number?
The NPI number for Blaine Radley is 1902483670. It was assigned to this individual provider in the NPPES registry on March 26, 2021.
Where is Blaine Radley located?
Blaine Radley practices at 653 W 8th St, Jacksonville, FL 32209. The listed phone number is (904) 244-2000.
What is Blaine Radley's specialty?
The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.
Is Blaine Radley enrolled in Medicare?
Yes. Blaine Radley is registered in the Medicare PECOS enrollment system.
When was this NPI record last updated?
The NPPES record for Blaine Radley was last updated on March 31, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Blaine Radley, DDS · NPI 1902483670
Student in an Organized Health Care Education/Training Program provider in Jacksonville, Florida. Individual provider, active in the CMS NPPES registry since March 26, 2021.
## Identity
- **NPI:** 1902483670 (Entity type: Individual)
- **Enumerated:** March 26, 2021
- **Primary specialty:** Student in an Organized Health Care Education/Training Program · taxonomy 390200000X
- **Sole proprietor:** Yes
## Practice location
- **Address:** 653 W 8TH ST, Jacksonville, FL 32209-6511
- **Phone:** (904) 244-2000
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health
## Record status
- **NPPES last updated:** March 31, 2022
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Source: [NPI Profile](https://npiprofile.com/npi/1902483670) · Data from the CMS NPPES public registry.