Individual provider Active NPI

Matthew Randal, AUD

  • Audiologist
  • Austin, TX
National Provider Identifier
1073358107
Registry record updated Jun 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
81611 Issued in TX
Practice address
4106 Marathon Blvd Ste a
Austin, TX 78756-3746
Phone
(512) 407-9215
NPI assigned
Jun 29, 2024
Last updated
Jun 29, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 81611 TX Primary

Addresses

Primary practice location

4106 Marathon Blvd Ste a
Austin, TX 78756-3746

Mailing address

4527 N Lamar Blvd Apt 6107
Austin, TX 78751-2381
Phone (303) 525-0529

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240802002916 TX Practitioner - Qualified Audiologist 3779020193 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Illuminear Tinnitus and Audiology CenterGroup PAC ID 2567786049, 3 clinicians

Practice addresses (Care Compare)

711 W 38TH St
B14
Austin, TX 78705-1136
Phone (512) 407-9215

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
81611TXMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Illuminear Tinnitus & Audiology Center Audiologist CurrentSince Jun 26, 2024 Accepting new patients

Locations

4106 Marathon Blvd
Ste A
Austin, TX 78756
Phone (512) 407-9215

711 W 38th St
Ste B14
Austin, TX 78705
Phone (512) 407-9215

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.

NPI Registry JSON

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

{
    "created_epoch": "1719619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719619200000",
    "number": "1073358107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4527 N LAMAR BLVD APT 6107",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787512381",
            "telephone_number": "303-525-0529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4106 MARATHON BLVD STE A",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787563746",
            "telephone_number": "512-407-9215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDAL",
        "first_name": "MATTHEW",
        "credential": "AUD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-29",
        "last_updated": "2024-06-29",
        "certification_date": "2024-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "TX",
            "license": "81611",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.