NPIMap

Individual provider Active NPI

Randall Waldner, M.D.

  • Family Medicine Physician
  • Redfield, SD
National Provider Identifier
1114451010
Registry record updated Aug 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
12172 Issued in SD
Practice address
111 W 10TH Ave
Redfield, SD 57469-1519
Phone
(605) 472-1110
Fax
(605) 472-0331
NPI assigned
Apr 18, 2017
Last updated
Aug 31, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 12172 SD Primary

Addresses

Primary practice location

111 W 10TH Ave
Redfield, SD 57469-1519

Mailing address

PO Box 590
Redfield, SD 57469-0590
Phone (605) 472-0510

Other practice location 1

1010 W 1st St
Redfield, SD 57469-1502
Phone (605) 472-0510

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
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
I20200820002220 SD Practitioner - Family Practice 1254609506 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Sanford School of Medicine of University of South Dakota, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
City of RedfieldGroup PAC ID 5698757631, 12 clinicians

Practice addresses (Care Compare)

1010 W 1St St
Redfield, SD 57469-1502
Phone (605) 472-0510

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.27 of 100Reported as apm
Quality
85.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
City of Redfield CurrentSince Sep 1, 2020 Accepting new patients
City of Redfield CurrentSince Apr 25, 2021 Accepting new patients
City of Redfield CurrentSince Jan 1, 2026 Accepting new patients
City of Redfield CurrentSince Sep 1, 2020 Accepting new patients
Redfield SD Skilled Nursing Facility LLC Past Accepting new patients
City of Redfield PastSince Sep 6, 2020 Accepting new patients

Locations

1010 W 1st St
Redfield, SD 57469
Phone (605) 472-0510

111 W 10th Ave
Redfield, SD 57469
Phone (605) 472-1110

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Avantara RedfieldRedfield, SD, CCN 435054 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2025
Jan 1, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 6

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.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1492473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598832000000",
    "number": "1114451010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 590",
            "city": "REDFIELD",
            "state": "SD",
            "postal_code": "574690590",
            "telephone_number": "605-472-0510",
            "fax_number": "605-472-0512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 W 10TH AVE",
            "city": "REDFIELD",
            "state": "SD",
            "postal_code": "574691519",
            "telephone_number": "605-472-1110",
            "fax_number": "605-472-0331"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1010 W 1st St",
            "address_purpose": "LOCATION",
            "city": "Redfield",
            "state": "SD",
            "postal_code": "574691502",
            "country_code": "US",
            "telephone_number": "605-472-0510",
            "fax_number": "605-472-0512",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALDNER",
        "first_name": "RANDALL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-18",
        "last_updated": "2020-08-31",
        "certification_date": "2020-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SD",
            "license": "12172",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redfield, SD

Sources for this page

Verify at the official NPI Registry.