Individual provider Active NPI

M. Barry Randall, M.D.

  • Dermatopathology (Pathology) Physician
  • Memphis, TN
National Provider Identifier
1124002175
Registry record updated Feb 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatopathology (Pathology) PhysicianTaxonomy code 207ZD0900X
License
29321 Issued in TN
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

Updated by the provider on Feb 25, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
133395001MedicaidAR
0121423MedicaidMS
1532078MedicaidTN

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100603000038 TN Practitioner - Pathology 3375672272 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
29321TNMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Shelby County Health Care Corporation Anatomic Pathology & Clinical Pathology CurrentSince Feb 19, 2015 Accepting new patients
Ut Medical Group, Inc. CurrentSince Nov 13, 2012 Accepting new patients
Shelby County Health Care Corporation CurrentSince Feb 19, 2015 Accepting new patients
Ut Medical Group Inc Anatomic Pathology & Clinical Pathology CurrentSince Nov 13, 2012 Accepting new patients
Utmg Dermatopathology, LLC PastSince Dec 1, 2012 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

  • Direct secure messaging: 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.

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

Verify at the official NPI Registry.