Active NPI
Glenn R Randall, MD
- Geriatric Medicine (Internal Medicine) Physician
- Worcester, MA
National Provider Identifier
1033170972
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Medicine (Internal Medicine) Physician
- License
- 80026
- Practice address
- 277 East Mountain St
Summit Eldercare
Worcester, MA 01606 - Phone
- (508) 852-2026
- Fax
- (508) 856-7130
- NPI assigned
- Mar 30, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 80026 | MA | |
| Geriatric Medicine (Internal Medicine) Physician | 207RG0300X | 80026 | MA | Primary |
| Hospice and Palliative Medicine (Internal Medicine) Physician | 207RH0002X | 80026 | MA |
Addresses
Primary practice location
277 East Mountain St
Summit Eldercare
Worcester, MA 01606
Mailing address
277 East Mountain St
Summit Eldercare
Worcester, MA 01606
Phone (508) 852-2026
Other identifiers 18
| Identifier | Type | State | Issuer |
|---|---|---|---|
| J14922 | Other | BLUE SHIELD INDEMNITY | |
| J14922 | Other | MEDICARE B | |
| 110175052 | Other | RAILROAD MEDICARE | |
| 27190 | Other | CHILDRENS MED SEC PLAN | |
| 27190 | Other | HEALTHY START | |
| 784073 | Other | MVP HEALTH CARE | |
| J14922 | Other | BLUE CARE ELECT | |
| J14922 | Other | BLUE SHIELD HMO BLUE | |
| 0400961 | Other | EVERCARE | |
| 042472266 | Other | HEALTHCARE VALUE MGMT | |
| 1061182 | Other | FIRST HEALTH | |
| 3131335 | Medicaid | MA | |
| 042472266 | Other | ONE HEALTH PLAN | |
| 042472266 | Other | PRIVATE HEALTHCARE SYSTEM | |
| 6633909 | Other | CIGNA HEALTH PLAN | |
| 7001328 | Other | AETNA US HEALTHCARE | |
| 991122 | Other | FALLON COMMUNITY HEALTH P | |
| AA2364 | Other | HARVARD PILGRIM HEALTHCAR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 80026 | MA | MD | Geriatric Medicine (Internal Medicine) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fallon Community Health Plan | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- PACE Provider Organization
- Worcester, MA
- NPI 1376696674
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143676800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389916800000",
"number": "1033170972",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "277 EAST MOUNTAIN ST",
"address_2": "SUMMIT ELDERCARE",
"city": "WORCESTER",
"state": "MA",
"postal_code": "01606",
"telephone_number": "508-852-2026",
"fax_number": "508-856-7130"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "277 EAST MOUNTAIN ST",
"address_2": "SUMMIT ELDERCARE",
"city": "WORCESTER",
"state": "MA",
"postal_code": "01606",
"telephone_number": "508-852-2026",
"fax_number": "508-856-7130"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDALL",
"first_name": "GLENN",
"middle_name": "R",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-30",
"last_updated": "2014-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MA",
"license": "80026",
"primary": false
},
{
"code": "207RG0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Geriatric Medicine",
"state": "MA",
"license": "80026",
"primary": true
},
{
"code": "207RH0002X",
"taxonomy_group": "",
"desc": "Internal Medicine, Hospice and Palliative Medicine",
"state": "MA",
"license": "80026",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD INDEMNITY",
"identifier": "J14922",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE B",
"identifier": "J14922",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "110175052",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHILDRENS MED SEC PLAN",
"identifier": "27190",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHY START",
"identifier": "27190",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MVP HEALTH CARE",
"identifier": "784073",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CARE ELECT",
"identifier": "J14922",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD HMO BLUE",
"identifier": "J14922",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EVERCARE",
"identifier": "0400961",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHCARE VALUE MGMT",
"identifier": "042472266",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST HEALTH",
"identifier": "1061182",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3131335",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ONE HEALTH PLAN",
"identifier": "042472266",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRIVATE HEALTHCARE SYSTEM",
"identifier": "042472266",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA HEALTH PLAN",
"identifier": "6633909",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA US HEALTHCARE",
"identifier": "7001328",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FALLON COMMUNITY HEALTH P",
"identifier": "991122",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM HEALTHCAR",
"identifier": "AA2364",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Worcester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.