Randall Phillips, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

146974 Issued in NY

Practice address

2780 Middle Country Rd Ste 210
Lake Grove, NY 11755-2120

Phone

(631) 588-4500

Fax

(631) 588-4595

NPI assigned

Nov 25, 2005

Last updated

Dec 4, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Azad K. Anand, MD, PC

  dba Long Island Diagnostic Imaging, PC

  • Diagnostic Radiology Physician
  • East Setauket, NY
  • NPI 1689700403
  NPD (past)
• Brookhaven Memorial Hospital Medical Center

  • Diagnostic Radiology Physician
  • Patchogue, NY
  • NPI 1114014065
  NPD (past)
• Preventive Diagnostics Inc

  • Mobile Radiology Clinic/Center
  • Brooklyn, NY
  • NPI 1184997041
  NPD (past)
• Preventive Diagnostics Inc

  • Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
  • Columbus, OH
  • NPI 1316254857
  NPD (past)

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

{
    "created_epoch": "1132876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512345600000",
    "number": "1154304962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2780 MIDDLE COUNTRY RD STE 210",
            "city": "LAKE GROVE",
            "state": "NY",
            "postal_code": "117552120",
            "telephone_number": "631-588-4500",
            "fax_number": "631-588-4595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2780 MIDDLE COUNTRY RD STE 210",
            "city": "LAKE GROVE",
            "state": "NY",
            "postal_code": "117552120",
            "telephone_number": "631-588-4500",
            "fax_number": "631-588-4595"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4 Cobbler Ln",
            "address_purpose": "LOCATION",
            "city": "East Setauket",
            "state": "NY",
            "postal_code": "117331168",
            "country_code": "US",
            "telephone_number": "952-595-1100",
            "fax_number": "612-294-4903",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "RANDALL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-25",
        "last_updated": "2017-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "146974",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angie Pashalis, LCSW
• Gino Francesco Pena, M.S.ED
• Patricia E Penna, RN
• Alexandra B Perkins, M.D.
• Joseph E Pfeifer, D.C.
• Mary Pierce
• Samantha Josephine Polidoro, LPN
• Brooke Elizabeth Postl, LMHC
• Precision Post-Op Care LLC (Precision Lymphatics)
• Sherry Preet

• Diagnostic Radiology Physician in Lake Grove, NY
• Providers in Lake Grove, NY by specialty
• Diagnostic Radiology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2017; 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.

Verify at the official NPI Registry.