NPIMap

Individual provider Active NPI

Kate Joanna Randolph, PA

  • Medical Physician Assistant
  • Sullivan, MO
National Provider Identifier
1033939749
Registry record updated Nov 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
2025000294 Issued in MO
Practice address
751 Sappington Bridge Rd
Dept Radiology
Sullivan, MO 63080-2354
Phone
(314) 996-5170
Fax
(314) 653-5832
NPI assigned
Oct 16, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 2025000294 MO Primary

Addresses

Primary practice location

751 Sappington Bridge Rd
Dept Radiology
Sullivan, MO 63080-2354

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (314) 996-5170

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250218000297 MO Practitioner - Physician Assistant 4789104019 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Washington UniversityGroup PAC ID 9830008770, 2,968 clinicians

Practice addresses (Care Compare)

510 S Kingshighway Blvd
Saint Louis, MO 63110-1016
Phone 31436272001

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Missouri Baptist Hospital of Sullivan CurrentSince Nov 10, 2025 Accepting new patients
Washington University CurrentSince Nov 1, 2025 Accepting new patients
SSM Health Care Group CurrentSince Feb 1, 2025 Accepting new patients
Missouri Baptist Hospital of Sullivan CurrentSince Nov 10, 2025 Accepting new patients
Missouri Baptist Hospital of Sullivan Past Accepting new patients

Locations

240 College St
Bourbon, MO 65441
Phone (573) 732-5004

102 Ozark Dr
#B
Cuba, MO 65453
Phone (573) 860-6600

10101 Woodfield Ln
Saint Louis, MO 63132
Phone (608) 280-4647

510 S Kingshighway Blvd
Saint Louis, MO 63110
Phone (314) 362-0177

751 Sappington Bridge Rd
Sullivan, MO 63080
Phone (573) 468-1343

Interoperability endpoints

  • FHIR API: https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Organizations & group practices 6

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1729036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762128000000",
    "number": "1033939749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412011",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742011",
            "telephone_number": "314-996-5170",
            "fax_number": "314-653-5832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 SAPPINGTON BRIDGE RD",
            "address_2": "DEPT RADIOLOGY",
            "city": "SULLIVAN",
            "state": "MO",
            "postal_code": "630802354",
            "telephone_number": "314-996-5170",
            "fax_number": "314-653-5832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "KATE",
        "middle_name": "JOANNA",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-16",
        "last_updated": "2025-11-03",
        "certification_date": "2025-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MO",
            "license": "2025000294",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "751 Sappington Bridge Rd",
            "address_2": "Dept Radiology",
            "city": "Sullivan",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630802354",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sullivan, MO

Sources for this page

Verify at the official NPI Registry.