Active NPI
Randolph Edward Smith, MD
- Anatomic Pathology & Clinical Pathology Physician
- Marquette, MI
National Provider Identifier
1063589216
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 4301046452
- Practice address
- 420 W Magnetic St
Marquette, MI 49855-2711 - Phone
- (906) 228-9440
- NPI assigned
- Nov 30, 2006
- Last updated
- Sep 4, 2007
- 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 |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 4301046452 | MI | Primary |
Addresses
Primary practice location
420 W Magnetic St
Marquette, MI 49855-2711
Mailing address
420 W Magnetic St
Marquette, MI 49855-2711
Phone (906) 228-9440
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2746796 | Medicaid | MI | |
| 34031400 | Medicaid | WI | |
| 1022271 | Other | MI | PREFERRED ONE |
| 2746796 | Other | MI | HEALTHPLAN OF MI |
| 2746496 | Other | MI | MOLINA HEALTHCARE |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164844800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1188864000000",
"number": "1063589216",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "420 W MAGNETIC ST",
"city": "MARQUETTE",
"state": "MI",
"postal_code": "498552711",
"telephone_number": "906-228-9440"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 W MAGNETIC ST",
"city": "MARQUETTE",
"state": "MI",
"postal_code": "498552711",
"telephone_number": "906-228-9440"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "RANDOLPH",
"middle_name": "EDWARD",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-30",
"last_updated": "2007-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "MI",
"license": "4301046452",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2746796",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "34031400",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "1022271",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPLAN OF MI",
"identifier": "2746796",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MOLINA HEALTHCARE",
"identifier": "2746496",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Marquette, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.