Randolph Harlen Robertson, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

18129 Issued in TN

Practice address

6119 W Jefferson Blvd
Fort Wayne, IN 46804-3072

Phone

(260) 432-1568

Fax

(260) 432-4969

NPI assigned

Jul 14, 2006

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

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

Practice roles

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.

• Summit Radiology P C

  • Diagnostic Radiology Physician
  • Fort Wayne, IN
  • NPI 1073584587
  NPD (past)
• Cookeville Regional Medical Center

  • Hospitalist Physician
  • Cookeville, TN
  • NPI 1023397031
  NPD (past)

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455494400000",
    "number": "1164448239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "142 W 5TH ST",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385011760",
            "telephone_number": "931-528-2541",
            "fax_number": "931-526-8814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6119 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468043072",
            "telephone_number": "260-432-1568",
            "fax_number": "260-432-4969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "RANDOLPH",
        "middle_name": "HARLEN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2016-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TN",
            "license": "18129",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0050269",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "300114288",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3037577",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "3156107",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201023920",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachel E Roberts, LCSW
• Teresa L Roberts, PMHNP-BC
• Tiffany Roberts, SLP
• Zachary L Roberts, PHARMD
• Ellen L Robertson, FNP
• Roy W Robertson, MD
• Laurette C Robey, MD
• Amanda Robinett, PT, DPT
• Summer Robinette
• Andrea Renee Robinson, MSW

• Diagnostic Radiology Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Diagnostic Radiology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.