Randy Keegan Idler, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

325526 Issued in NY

Practice address

50 Staniford St
Boston, MA 02114-2517

Phone

(617) 903-5000

NPI assigned

May 11, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NY, MA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Family Practice

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mass General Brigham Community Physicians IncGroup PAC ID 1759273436, 430 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Mass General Brigham Community Physicians Inc.

  • Internal Medicine Physician
  • Haverhill, MA
  • NPI 1891112637
  Medicare reassignment Care Compare group NPD
• Mount Sinai School of Medicine

  • Family Medicine Physician
  • New York, NY
  • NPI 1528538774
  Medicare reassignment NPD
• Mass General Brigham Community Physicians Inc

  • Cardiovascular Disease Physician
  • Medford, MA
  • NPI 1548638265
  NPD
• Mass General Brigham Community Physicians Inc.

  • Internal Medicine Physician
  • Concord, MA
  • NPI 1174545875
  NPD (past)
• Mass General Brigham Community Physicians Inc.

  • Family Medicine Physician
  • Boston, MA
  • NPI 1265094122
  NPD (past)
• Mount Sinai School of Medicine

  • Internal Medicine Physician
  • Manhasset, NY
  • NPI 1144659749
  NPD (past)

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

{
    "created_epoch": "1589155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726704000000",
    "number": "1174145353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8502 FORT HAMILTON PKWY APT 3B",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112094816",
            "telephone_number": "775-636-0076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 STANIFORD ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142517",
            "telephone_number": "617-903-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "65 James St",
            "address_purpose": "LOCATION",
            "city": "Edison",
            "state": "NJ",
            "postal_code": "088203947",
            "country_code": "US",
            "telephone_number": "732-321-7493",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "185 Broadway Fl 2",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100070167",
            "country_code": "US",
            "telephone_number": "888-663-6331",
            "fax_number": "415-252-7176",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IDLER",
        "first_name": "RANDY",
        "middle_name": "KEEGAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-05-11",
        "last_updated": "2024-09-19",
        "certification_date": "2024-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "1019991",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "325526",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Identity and Mental Health Project LLC
• Idg Boston High Street Dental PC
• Idg Boston PO Square Dental PC
• Jared Thomas Iding, MD
• Samir Idjeri
• Azza H Idris, MD,PHD
• Henrietta Imade Idumwonyi, BSN, RN
• Oghogho Joyce Idumwonyi
• Michael H. Ieong, M.D.
• Osahon Nelson Igbinoba, DMD,BDS

• Family Medicine Physician in Boston, MA
• Providers in Boston, MA by specialty
• Family Medicine Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2024; 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.