Individual provider Active NPI

Ashanta S Randolph, FNP

  • Family Nurse Practitioner
  • Houston, TX
National Provider Identifier
1194301515
Registry record updated Jan 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1032753 Issued in TX
Practice address
4700 W Sam Houston Pkwy N Ste 220
Houston, TX 77041-8224
Phone
(713) 402-7824
Fax
(713) 570-0196
NPI assigned
Mar 24, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 1032753 TX Primary

Addresses

Primary practice location

4700 W Sam Houston Pkwy N Ste 220
Houston, TX 77041-8224

Mailing address

602 W Grand Pkwy S
Katy, TX 77494-8328

Other names 1

  • Ashanta S Parker Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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 1

Enrollment IDStateProvider typePAC IDDetails
I20211026002214 TX Practitioner - Nurse Practitioner 1759779655 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Texas Medical Branch at Galveston, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellmed Medical Group PAGroup PAC ID 4880657386, 666 clinicians

Practice addresses (Care Compare)

San Antonio, TX 78257
Phone (210) 617-4706

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1032753TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Wellmed Medical Group, P.a. CurrentSince Sep 10, 2022 Accepting new patients
Wellmed Medical Group, PA CurrentSince Sep 10, 2022 Accepting new patients

Locations

4700 W Sam Houston Pkwy N
Ste 220
Houston, TX 77041
Phone (713) 402-7824

8637 Fredericksburg Rd
Ste 360
San Antonio, TX 78240
Phone (210) 304-3500

6157 NW Loop 410
Ste 124
San Antonio, TX 78238
Phone (210) 523-1411

448 Castroville Rd
San Antonio, TX 78207
Phone (210) 434-1400

19500 Ih 10 W
#15030
San Antonio, TX 78257
Phone (210) 617-4607

Interoperability endpoints

  • Direct secure messaging: ashanta.randolph@wellmed.eclinicaldirectplus.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1616544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672704000000",
    "number": "1194301515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 W GRAND PKWY S",
            "city": "KATY",
            "state": "TX",
            "postal_code": "774948328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 W SAM HOUSTON PKWY N STE 220",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770418224",
            "telephone_number": "713-402-7824",
            "fax_number": "713-570-0196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "ASHANTA",
        "middle_name": "S",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-24",
        "last_updated": "2023-01-03",
        "certification_date": "2023-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1032753",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ASHANTA",
            "last_name": "PARKER",
            "middle_name": "S",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.