Individual provider Active NPI

Randall Wayne Young, CRNA

  • Certified Registered Nurse Anesthetist
  • Longview, TX
National Provider Identifier
1124064258
Registry record updated Aug 14, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
660218 Issued in TX
Practice address
906 Judson Rd
Longview, TX 75601-5113
Phone
(903) 331-0506
Fax
(903) 331-0462
NPI assigned
Jun 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 72566 TX
Certified Registered Nurse Anesthetist 367500000X 660218 TX Primary

Addresses

Primary practice location

906 Judson Rd
Longview, TX 75601-5113

Mailing address

P.O. Box 2527
Longview, TX 75606-2527
Phone (903) 331-0506

Other identifiers 2

IdentifierTypeStateIssuer
171-84-7001MedicaidTX
171847001MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050223000685 TX Practitioner - Certified Registered Nurse Anesthetist (Crna) 4880647494 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Christus Good Shepherd Medical CenterGroup PAC ID 3779565544, 30 clinicians

Practice addresses (Care Compare)

700 E Marshall Ave
Longview, TX 75601-5580
Phone (903) 315-2000

Hospital & facility affiliations

  • Christus Good Shepherd Medical Center Hospital, Longview, TX, CCN 450032

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
72566TXMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Christus Good Shepherd Medical Center Nurse Anesthetist, Certified Registered CurrentSince Sep 1, 2017 Accepting new patients
Christus Good Shepherd Medical Center CurrentSince Sep 1, 2017 Accepting new patients
Anesthesia Consultants Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

700 E Marshall Ave
Longview, TX 75601
Phone (903) 236-2000

811 S Washington Ave
Marshall, TX 75670
Phone (903) 315-1488

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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": "1150761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1250208000000",
    "number": "1124064258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 2527",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756062527",
            "telephone_number": "903-331-0506",
            "fax_number": "903-331-0462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "906 JUDSON RD",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756015113",
            "telephone_number": "903-331-0506",
            "fax_number": "903-331-0462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "RANDALL",
        "middle_name": "WAYNE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-20",
        "last_updated": "2009-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "72566",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "660218",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "171-84-7001",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "171847001",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.