Randolph A Ibarra, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

14645 Issued in TX

Practice address

8744 Grissom Rd
San Antonio, TX 78251-4819

Phone

(210) 523-0000

Fax

(210) 523-0067

NPI assigned

Apr 5, 2006

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

Medicare fee-for-service enrollment

Enrolled in TX

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

Networks

• TX HMO D-SNP
• NM HMO C-SNP

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.

• Thomas R Watkins,DDS and Associates

  • General Practice Dentistry
  • San Antonio, TX
  • NPI 1588844575
  NPD (past)

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

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1003878034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8355 CRESTWAY DR",
            "address_2": "1126",
            "city": "CONVERSE",
            "state": "TX",
            "postal_code": "781093596",
            "telephone_number": "210-623-6112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8744 GRISSOM RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782514819",
            "telephone_number": "210-523-0000",
            "fax_number": "210-523-0067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBARRA",
        "first_name": "RANDOLPH",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "14645",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jordan Marshall Ibarra, PHARMD
• Kristen Ibarra, CCC-SLP
• Lisa R Ibarra
• Maria Graciela Ibarra, PTA
• Miguel Ibarra, PHARM.D.
• Sofia Ibarra
• Mariam Majed Ibdaiwi, MD
• Richard Ibitola Ibitayo, FNP
• Hussen H Ibn-Ahmed, BDS
• Anas Ibrahim-Hamdan, M.D.

• General Practice Dentistry in San Antonio, TX
• Providers in San Antonio, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.