Kimberly M Randolph, APN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

7234 Issued in TN

Practice address

3180 Professional PLZ
Ste 111
Germantown, TN 38138-1534

Phone

(901) 854-5455

Fax

(901) 861-7736

NPI assigned

Mar 23, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN, GA, SC3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Specialty

Nurse Practitioner

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/HEBDBA/Endpoint/HEBDBA

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.

• Collierville Pediatrics, LLC

  • Pediatrics Physician
  • Collierville, TN
  • NPI 1326229345
  Medicare reassignment NPD
• Midsouth Independent Group, PLLC

  • Internal Medicine Physician
  • Memphis, TN
  • NPI 1861009326
  Medicare reassignment NPD
• City of Hope Medical Group of Georgia LLC

  • Internal Medicine Physician
  • Newnan, GA
  • NPI 1447520333
  Medicare reassignment NPD
• Nasoncare, LLC

  • Primary Care Clinic/Center
  • North Charleston, SC
  • NPI 1346705522
  Medicare reassignment NPD
• Jackson Clinic PA

  • Durable Medical Equipment & Medical Supplies
  • Jackson, TN
  • NPI 1689443038
  NPD (past)

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

{
    "created_epoch": "1269302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617235200000",
    "number": "1144544982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3180 PROFESSIONAL PLZ",
            "address_2": "STE 111",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381381534",
            "telephone_number": "901-854-5455",
            "fax_number": "901-861-7736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3180 PROFESSIONAL PLZ",
            "address_2": "STE 111",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381381534",
            "telephone_number": "901-854-5455",
            "fax_number": "901-861-7736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "KIMBERLY",
        "middle_name": "M",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-23",
        "last_updated": "2021-04-01",
        "certification_date": "2021-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": "7234",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1518380",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joel Mukesh Raja
• Sailaja Raju, M.D.
• Rajesh Ramachandran, M.D.
• Anna Johnson Rambo, M.D.
• Abigail Marie Ramsey
• Randy Villanueva MD PC
• Tunja Rash, APN, FNP-BC
• Karen Ratliff, LCSW
• Thomas Warren Ratliff, MD
• William Thomas Rawlinson, MD

• Nurse Practitioner in Germantown, TN
• Providers in Germantown, TN by specialty
• Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2021; 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.
• 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.