Individual provider Active NPI

Jessica Vernola Randolph, DPM

  • Foot & Ankle Surgery Podiatrist
  • Glendale, AZ
National Provider Identifier
1053788000
Registry record updated Apr 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
POD-000891 Issued in AZ
Practice address
6677 W Thunderbird Rd Ste J171
Glendale, AZ 85306-3703
Phone
(623) 226-5442
NPI assigned
Aug 25, 2015
Last updated
Apr 15, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X POD-000891 AZ
Foot & Ankle Surgery Podiatrist 213ES0103X POD-000891 AZ Primary

Addresses

Primary practice location

6677 W Thunderbird Rd Ste J171
Glendale, AZ 85306-3703

Mailing address

6635 W Happy Valley Rd Ste A104-276
Glendale, AZ 85310-2609
Phone (623) 330-0279

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20180801003328 AZ Practitioner - Podiatry 9133477581 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

6677 W Thunderbird Rd
Suite J171
Glendale, AZ 85306-3703
Phone (623) 226-5442

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Melanoma (skin cancer) excision1-10
Removal of tissue206
Removal of skin lesions1-10
Removal of nail tissue88
Removal or shaving of skin growth43

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
POD-000891AZMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
On Point Podiatry PLLC Podiatrist CurrentSince Feb 20, 2018 Accepting new patients

Locations

6635 W Happy Valley Rd
Ste A104276
Glendale, AZ 85310

6677 W Thunderbird Rd
Ste J171
Glendale, AZ 85306
Phone (602) 795-7256

20333 N 19th Ave
Ste 230
Phoenix, AZ 85027
Phone (480) 707-9504

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1440460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744675200000",
    "number": "1053788000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6635 W HAPPY VALLEY RD STE A104-276",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853102609",
            "telephone_number": "623-330-0279",
            "fax_number": "480-383-6308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6677 W THUNDERBIRD RD STE J171",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853063703",
            "telephone_number": "623-226-5442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "JESSICA",
        "middle_name": "VERNOLA",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-25",
        "last_updated": "2025-04-15",
        "certification_date": "2025-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "AZ",
            "license": "POD-000891",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "AZ",
            "license": "POD-000891",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

Verify at the official NPI Registry.