NPIMap

Individual provider Active NPI

Derrick Randdolf, MD

  • Family Medicine Physician
  • Odessa, TX
National Provider Identifier
1104205343
Registry record updated Feb 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
R4622 Issued in TX
Practice address
701 W 5TH St
Odessa, TX 79763-4206
Phone
(432) 703-5375
Fax
(432) 703-5238
NPI assigned
May 20, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X R4622 TX
Family Medicine Physician 207Q00000X R4622 TX Primary

Addresses

Primary practice location

701 W 5TH St
Odessa, TX 79763-4206

Mailing address

24165 W Interstate 10 Ste 202
San Antonio, TX 78257-1160
Phone (726) 225-2290

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171130001563 TX Practitioner - Family PracticePractitioner - Emergency Medicine 8426348178 Reassigns benefits to 14 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Concord Medical Group PLLC Emergency Medicine CurrentSince Nov 1, 2017 Accepting new patients
Travis County Emergency Physicians PA Emergency Medicine CurrentSince Feb 1, 2023 Accepting new patients
Brain Coach LLC CurrentSince Aug 17, 2024 Accepting new patients
Concord Medical Group of Texas PLLC Emergency Medicine CurrentSince Nov 1, 2017 Accepting new patients
Seminole Hospital District of Gaines County Texas CurrentSince Oct 1, 2019 Accepting new patients
Hospitalist Medicine Physicians of Texas - Houston, PLLC Emergency Medicine CurrentSince Jan 1, 2023 Accepting new patients
Third Coast Emergency Physicians Southwest PA Emergency Medicine CurrentSince Nov 29, 2022 Accepting new patients
Randdolf Physicians PLLC Family Medicine CurrentSince Aug 21, 2024 Accepting new patients
Emergency Associates of Central Texas PA Emergency Medicine CurrentSince Jun 1, 2024 Accepting new patients
Odessa Physician Associates, PLLC Emergency Medicine CurrentSince Oct 28, 2022 Accepting new patients
Hospital Care Consultants, Inc Emergency Medicine CurrentSince Nov 1, 2021 Accepting new patients
Seminole Hospital District of Gaines County Texas Emergency Medicine CurrentSince Oct 1, 2019 Accepting new patients
Hospital Care Consultants of Corpus Christi Emergency Medicine CurrentSince Nov 1, 2021 Accepting new patients
Hospitalist Medicine Physicians of Texas, PLLC Family Medicine CurrentSince Mar 21, 2025 Accepting new patients
Sound Physicians Emergency Medicine of Texas PLLC Emergency Medicine CurrentSince Aug 1, 2024 Accepting new patients

Locations

1007 S William St
Atlanta, TX 75551
Phone (903) 614-2000

7900 Ranch Road 1826
Austin, TX 78737
Phone (512) 324-5305

1601 W 11th Pl
Big Spring, TX 79720
Phone (432) 263-1211

200 S Geneva St
Breckenridge, TX 76424
Phone (254) 559-2241

6130 Parkway Dr
Corpus Christi, TX 78414
Phone (361) 826-5785

3201 W State Highway 22
Corsicana, TX 75110
Phone (903) 654-6800

12101 Edgemere Blvd
El Paso, TX 79938
Phone (915) 832-2490

310 W South St
Henrietta, TX 76365
Phone (806) 647-2191

1275 Marvin Hancock Dr
Jasper, TX 75951
Phone (409) 384-1951

2201 Clear Creek Rd
Killeen, TX 76549
Phone (254) 519-8185

6001 Kyle Pkwy
Kyle, TX 78640
Phone (512) 504-5000

100 Medical Pkwy
Lakeway, TX 78738
Phone (512) 206-8100

3640 Hampton Dr
Missouri City, TX 77459
Phone (281) 778-5144

900 E 4th St
Odessa, TX 79761
Phone (432) 362-9900

520 E 6th St
Odessa, TX 79761
Phone (432) 332-0929

3600 Gates Blvd
Port Arthur, TX 77642
Phone (409) 985-7431

22211 W Interstate 10
Ste 1206
San Antonio, TX 78257
Phone (210) 888-0368

4103 N Loop 1604 W
San Antonio, TX 78249
Phone (210) 572-8415

18600 Hardy Oak Blvd
San Antonio, TX 78258
Phone (210) 404-0800

24165 W Interstate 10
Ste 202
San Antonio, TX 78257
Phone (210) 265-5920

343 W Houston St
Ste 107
San Antonio, TX 78205
Phone (210) 223-2601

209 NW 8th St
Seminole, TX 79360
Phone (432) 758-5811

600 E Interstate 20
Stanton, TX 79782
Phone (432) 607-3200

305 N McKinney St
Sweeny, TX 77480
Phone (979) 548-1500

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Emergency Medicine
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Concord Medical Group of Texas PLLC 319 clinicians
Brain Coach LLC 3 clinicians

Practice addresses (Care Compare)

1601 W 11TH PL
Big Spring, TX 79720-4114
Phone (432) 263-1211

24165 W Interstate 10
Suite 202
San Antonio, TX 78257-1160
Phone (210) 265-5920

24165 W Interstate 10 Frontage Rd
San Antonio, TX 78257
Phone (210) 332-5298

Hospital & facility affiliations

  • Baptist Neighborhood Hospital Thousand Oaks Hospital, San Antonio, TX, CCN 670078
  • Scenic Mountain Medical Center Hospital, Big Spring, TX, CCN 450653
  • Hill Country Memorial Hospital Hospital, Fredericksburg, TX, CCN 450604
  • Adventhealth Central Texas Hospital, Killeen, TX, CCN 450152

Merit-based Incentive Payment System (MIPS)

Final score
93.86 of 100Reported as group
Quality
92.78
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
87.3 of 100Reported as group
Quality
76.18
Improvement activities
40

NPI Registry JSON

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

{
    "created_epoch": "1432080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740528000000",
    "number": "1104205343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24165 W INTERSTATE 10 STE 202",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782571160",
            "telephone_number": "726-225-2290",
            "fax_number": "281-845-7063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 W 5TH ST",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797634206",
            "telephone_number": "432-703-5375",
            "fax_number": "432-703-5238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDDOLF",
        "first_name": "DERRICK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-20",
        "last_updated": "2025-02-26",
        "certification_date": "2025-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "R4622",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "R4622",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Odessa, TX

Sources for this page

Verify at the official NPI Registry.