Active NPI
M. Barry Randall, M.D.
- Dermatopathology (Pathology) Physician
- Memphis, TN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatopathology (Pathology) Physician
- License
- 29321
- Practice address
- 930 Madison Ave
Suite 890
Memphis, TN 38103-3410 - Phone
- (901) 866-8834
- Fax
- (901) 302-2834
- NPI assigned
- Dec 2, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 29321 | TN | |
| Dermatopathology (Pathology) Physician | 207ZD0900X | 29321 | TN | Primary |
Addresses
Primary practice location
930 Madison Ave
Suite 890
Memphis, TN 38103-3410
Mailing address
1068 Cresthaven Rd Ste 300
Memphis, TN 38119-0809
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 133395001 | Medicaid | AR | |
| 0121423 | Medicaid | MS | |
| 1532078 | Medicaid | TN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29321 | TN | MD | Anatomic Pathology & Clinical Pathology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shelby County Health Care Corporation | Anatomic Pathology & Clinical Pathology | Current | Accepting new patients |
| Ut Medical Group, Inc. | Current | Accepting new patients | |
| Shelby County Health Care Corporation | Current | Accepting new patients | |
| Ut Medical Group Inc | Anatomic Pathology & Clinical Pathology | Current | Accepting new patients |
| Utmg Dermatopathology, LLC | Past | Accepting new patients |
Locations
930 Madison Ave
Ste 890
Memphis, TN 38103
Phone (901) 866-8834
877 Jefferson Ave
Memphis, TN 38103
Phone (901) 448-5893
930 Madison Ave
Ste 200
Memphis, TN 38103
Phone (901) 448-6650
1211 Union Ave
Ste 300
Memphis, TN 38104
Phone (901) 725-7551
1407 Union Ave
Ste 700
Memphis, TN 38104
Phone (901) 866-8360
1068 Cresthaven Rd
Ste 300
Memphis, TN 38119
Phone (901) 683-0024
Interoperability endpoints
- milton.randall.p3@direct.uthsc.nextgenshare.com
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.
-
- Anatomic Pathology & Clinical Pathology Physician
- Memphis, TN
- NPI 1780685750
-
- Multi-Specialty Clinic/Center
- Memphis, TN
- NPI 1780676650
Anatomic Pathology & Clinical Pathology
-
- Clinical Medical Laboratory
- Memphis, TN
- NPI 1922343623
-
- Clinic Pharmacy
- Memphis, TN
- NPI 1629542493
-
- Ophthalmology Physician
- Memphis, TN
- NPI 1326919200
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133481600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1740441600000",
"number": "1124002175",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1068 CRESTHAVEN RD STE 300",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381190809"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "930 MADISON AVE",
"address_2": "SUITE 890",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381033410",
"telephone_number": "901-866-8834",
"fax_number": "901-302-2834"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDALL",
"first_name": "M.",
"middle_name": "BARRY",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-02",
"last_updated": "2025-02-25",
"certification_date": "2025-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "TN",
"license": "29321",
"primary": false
},
{
"code": "207ZD0900X",
"taxonomy_group": "",
"desc": "Pathology, Dermatopathology",
"state": "TN",
"license": "29321",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "133395001",
"state": "AR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0121423",
"state": "MS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1532078",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Memphis, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.