Randolph Medical Practices PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME46235 Issued in FL

Legal business name

RANDOLPH MEDICAL PRACTICES PA

Practice address

1847 SW Barnett Way
Lake City, FL 32025-6957

Phone

(386) 755-1440

Fax

(386) 758-5628

NPI assigned

Sep 22, 2006

Organization subpart

No

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

Authorized official

Name

Tommy Lavaughn RandolphNPI 1992805881

Title

MD

Phone

(386) 755-1440

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tommy Lavaughn Randolph, M.D.

  • Family Medicine Physician
  • Lake City, FL
  • NPI 1992805881
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540944000000",
    "number": "1144320052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1847 SW BARNETT WAY",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320256957",
            "telephone_number": "386-755-1440",
            "fax_number": "386-758-5628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1847 SW BARNETT WAY",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320256957",
            "telephone_number": "386-755-1440",
            "fax_number": "386-758-5628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANDOLPH MEDICAL PRACTICES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2018-10-31",
        "status": "A",
        "authorized_official_last_name": "RANDOLPH",
        "authorized_official_first_name": "TOMMY",
        "authorized_official_middle_name": "LAVAUGHN",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "386-755-1440"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME46235",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME51982",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256113100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "38690",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rajani Ravindra MD
• Parvathamma - Rajasekhar, M.D
• Ramkissoon Weiss Dental PLLC
• Johann Ramkissoon, DMD
• Kay B Ramnarine, PHARM D
• Amelia Randolph, DMD, MS
• David F Randolph, DMD
• Tommy Lavaughn Randolph, M.D.
• Britany Ratliff
• Julie Marie Rattley, CMSW

• Family Medicine Physician in Lake City, FL
• Providers in Lake City, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2018; 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.