Active NPI
Donald Randall, PHD
- Clinical Psychologist
- Bountiful, UT
National Provider Identifier
1053346494
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2663822501
- Practice address
- 630 Medical Dr
Bountiful, UT 84010-4908 - Phone
- (801) 299-2186
- NPI assigned
- Jul 12, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2663822501 | UT | Primary |
Addresses
Primary practice location
630 Medical Dr
Bountiful, UT 84010-4908
Mailing address
630 Medical Dr
Bountiful, UT 84010-4908
Phone (801) 299-2186
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 876000308007 | Medicaid | UT | |
| 260022408 | Other | RAILROAD MEDICARE |
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 Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2663822501 | UT | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1381968000000",
"number": "1053346494",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "630 MEDICAL DR",
"city": "BOUNTIFUL",
"state": "UT",
"postal_code": "840104908",
"telephone_number": "801-299-2186"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 MEDICAL DR",
"city": "BOUNTIFUL",
"state": "UT",
"postal_code": "840104908",
"telephone_number": "801-299-2186"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDALL",
"first_name": "DONALD",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-12",
"last_updated": "2013-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "UT",
"license": "2663822501",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "876000308007",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "260022408",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Bountiful, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.