Benjamin Randall, ATC

Primary specialty

Other Specialist/TechnologistTaxonomy code 246Z00000X

License

AT509 Issued in ME

Practice address

5747 Memorial Gym University of Maine
Orono, ME 04469-0001

Phone

(207) 581-1088

NPI assigned

Dec 16, 2015

Sex

Male

Sole proprietor

Yes

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

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1450224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450224000000",
    "number": "1184089203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5747 MEMORIAL GYM UNIVERSITY OF MAINE",
            "city": "ORONO",
            "state": "ME",
            "postal_code": "044690001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5747 MEMORIAL GYM UNIVERSITY OF MAINE",
            "city": "ORONO",
            "state": "ME",
            "postal_code": "044690001",
            "telephone_number": "207-581-1088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDALL",
        "first_name": "BENJAMIN",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-12-16",
        "last_updated": "2015-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246Z00000X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other",
            "state": "ME",
            "license": "AT509",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gavin Pickering, M.ED.
• Constance A Poulin, LCSW CCS
• Robyn L Pride
• John Quinn, LCSW
• Glenn Stephen Rampe, M.D.
• Garrett A Randolph, L.C.S.W.
• Renew Health PLLC
• Susan Kay Riley, MS CCCSLP
• Daryne M Rockett, LCSW
• Joanna Fichthorn Rosebush, PHD

• Other Specialist/Technologist in Orono, ME
• Providers in Orono, ME by specialty
• Other Specialist/Technologist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2015; 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.