NPIMap

Organization Active NPI

Randolph Medical Associates

  • Sonography Specialist/Technologist Cardiovascular
  • Roanoke, AL
National Provider Identifier
1104003987
Registry record updated Jan 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sonography Specialist/Technologist CardiovascularTaxonomy code 246XS1301X
License
D0436 Issued in AL
Legal business name
RANDOLPH MEDICAL ASSOCIATES
Practice address
965 US Hwy 431
Roanoke, AL 36274
Phone
(334) 863-2150
Fax
(334) 863-8733
NPI assigned
Jan 24, 2008
Organization subpart
Yes
Parent organization
RANDOLPH MEDICAL ASSOCIATESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 24, 2008

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

Authorized official

Name
Dr. Russell Doak Peterson, DONPI 1144322504
Title
Owner
Phone
(334) 863-2150

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sonography Specialist/Technologist CardiovascularGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 246XS1301X D0436 AL Primary

Addresses

Primary practice location

965 US Hwy 431
Roanoke, AL 36274

Mailing address

PO Box 625
Roanoke, AL 36274-0625
Phone (334) 863-2150

Other identifiers 2

IdentifierTypeStateIssuer
51091244OtherALBCBS
E26656OtherALUPIN

Other names 1

  • IMAGING MOBILITY UNIT Doing business as

National Provider Directory

National Provider Directory
Part of
Randolph Med Assoc PC

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1201132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201132800000",
    "number": "1104003987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 625",
            "city": "ROANOKE",
            "state": "AL",
            "postal_code": "362740625",
            "telephone_number": "334-863-2150",
            "fax_number": "334-863-8733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "965 US HWY 431",
            "city": "ROANOKE",
            "state": "AL",
            "postal_code": "36274",
            "telephone_number": "334-863-2150",
            "fax_number": "334-863-8733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANDOLPH MEDICAL ASSOCIATES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RANDOLPH MEDICAL ASSOCIATES",
        "enumeration_date": "2008-01-24",
        "last_updated": "2008-01-24",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "DOAK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "334-863-2150",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "246XS1301X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist/Technologist Cardiovascular, Sonography",
            "state": "AL",
            "license": "D0436",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "51091244",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "E26656",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IMAGING MOBILITY UNIT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roanoke, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.