Individual provider Active NPI

Ward Randall Warren, M.D.

  • Emergency Medicine Physician
  • Augusta, GA
National Provider Identifier
1104099936
Registry record updated Jun 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
063045 Issued in GA
Practice address
1350 Walton Way
C/O Emergency Department University Hospital
Augusta, GA 30901-2612
Phone
(706) 774-5304
NPI assigned
Apr 13, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 20, 2012

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

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 4301088702 MI
Emergency Medicine Physician 207P00000X 063045 GA Primary
Emergency Medicine Physician 207P00000X TD091110 ME
Emergency Medicine Physician 207P00000X P2080 TX
Emergency Medicine Physician 207P00000X 33294 SC
Emergency Medicine Physician 207P00000X ME 109750 FL
Emergency Medicine Physician 207P00000X D0071741 MD
Emergency Medicine Physician 207P00000X 169289 NC
Emergency Medicine Physician 207P00000X 2012007898 MO

Addresses

Primary practice location

1350 Walton Way
C/O Emergency Department University Hospital
Augusta, GA 30901-2612

Mailing address

3709 W Lake Dr
Martinez, GA 30907-9407
Phone (706) 496-8841

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV, VA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170929002594 WV Practitioner - Emergency Medicine 7618013970 Reassigns benefits to 2 organizations
I20190115001620 VA Practitioner - Emergency Medicine 7618013970 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME 109750FLMDEmergency Medicine Physician
063045GAMDEmergency Medicine Physician
D0071741MDMDEmergency Medicine Physician
TD091110MEMDEmergency Medicine Physician
4301088702MIMDEmergency Medicine Physician
2012007898MOMDEmergency Medicine Physician
169289NCMDEmergency Medicine Physician
33294SCMDEmergency Medicine Physician
P2080TXMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Health Care Alliance, Inc. Emergency Medicine CurrentSince Aug 1, 2017 Accepting new patients
Med Now Urgent Care, LLC CurrentSince Dec 19, 2009 Accepting new patients
Emergency Coverage, LLC Emergency Medicine CurrentSince Sep 1, 2018 Accepting new patients
Greenbrier Emergency Services, Inc. Emergency Medicine CurrentSince Aug 1, 2017 Accepting new patients
Blue Job Emergency Physicians LLC Emergency Medicine Past Accepting new patients

Locations

104 N Belair Rd
Ste 101
Evans, GA 30809
Phone (706) 799-5664

1710 Harper Rd
Beckley, WV 25801
Phone (304) 252-0641

20 Hospital Dr
Logan, WV 25601
Phone (304) 792-1101

601 Colliers Way
Weirton, WV 26062
Phone (304) 364-5156

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1208044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340150400000",
    "number": "1104099936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3709 W LAKE DR",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309079407",
            "telephone_number": "706-496-8841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 WALTON WAY",
            "address_2": "C/O EMERGENCY DEPARTMENT UNIVERSITY HOSPITAL",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309012612",
            "telephone_number": "706-774-5304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARREN",
        "first_name": "WARD",
        "middle_name": "RANDALL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-04-13",
        "last_updated": "2012-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "4301088702",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "063045",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "ME",
            "license": "TD091110",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "P2080",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "SC",
            "license": "33294",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "ME 109750",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MD",
            "license": "D0071741",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "169289",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MO",
            "license": "2012007898",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

Verify at the official NPI Registry.