Organization Active NPI

Randall a Riegler MD PA

  • Otolaryngology Physician
  • Jacksonville, FL
National Provider Identifier
1023354461
Registry record updated Dec 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
ME0050465 Issued in FL
Legal business name
RANDALL A RIEGLER MD PA
Practice address
8614 Baymeadows Way
Suite 101
Jacksonville, FL 32256-8236
Phone
(904) 448-4640
Fax
(904) 448-7120
NPI assigned
Dec 12, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2012

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

Authorized official

Name
Randall Albert Riegler, MDNPI 1467413120
Title
Owner
Phone
(904) 448-4640

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Y00000X ME0050465 FL Primary

Addresses

Primary practice location

8614 Baymeadows Way
Suite 101
Jacksonville, FL 32256-8236

Mailing address

8614 Baymeadows Way
Suite 101
Jacksonville, FL 32256-8236
Phone (904) 448-4640

Other identifiers 1

IdentifierTypeStateIssuer
046935100MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121221000305 FL Part B Supplier - Clinic/Group Practice 3476705468 Receives reassigned benefits from 1 practitioner
Practice locations: Jacksonville, FL

National Provider Directory

National Provider Directory

Locations

8515 Baymeadows Way
Ste 301
Jacksonville, FL 32256

8614 Baymeadows Way
#101
Jacksonville, FL 32256
Phone (904) 448-4640

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1355270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355270400000",
    "number": "1023354461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8614 BAYMEADOWS WAY",
            "address_2": "SUITE 101",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322568236",
            "telephone_number": "904-448-4640",
            "fax_number": "904-448-7120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8614 BAYMEADOWS WAY",
            "address_2": "SUITE 101",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322568236",
            "telephone_number": "904-448-4640",
            "fax_number": "904-448-7120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANDALL A RIEGLER MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-12",
        "last_updated": "2012-12-12",
        "status": "A",
        "authorized_official_last_name": "RIEGLER",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "ALBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-448-4640",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": "FL",
            "license": "ME0050465",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046935100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.