Individual provider Active NPI

Mercedes Randolph, APRN

  • Pediatric Nurse Practitioner
  • Warren, OH
National Provider Identifier
1205576394
Registry record updated May 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
APRN.CNP.0031362 Issued in OH
Practice address
661 Mahoning Ave NW
Warren, OH 44483-3457
Phone
(330) 399-8716
NPI assigned
Mar 29, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Registered Nurse 163WP0200X RN.462653 OH
Pediatric Nurse Practitioner 363LP0200X APRN.CNP.0031362 OH Primary

Addresses

Primary practice location

661 Mahoning Ave NW
Warren, OH 44483-3457

Mailing address

661 Mahoning Ave NW
Warren, OH 44483

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN.462653OHMDPediatric Registered Nurse
APRN.CNP.0031362OHMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Akron Children's Hospital Current Accepting new patients
Children's Hospital Medical Center of Akron PastSince May 26, 2024 Accepting new patients
Children's Hospital Medical Center of Akron PastSince May 26, 2024 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: mrandolph122400@direct.chmca.org

Organizations & group practices 3

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": "1648512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716422400000",
    "number": "1205576394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "661 MAHONING AVE NW",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "44483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "661 MAHONING AVE NW",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "444833457",
            "telephone_number": "330-399-8716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "MERCEDES",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-29",
        "last_updated": "2024-05-23",
        "certification_date": "2024-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Pediatrics",
            "state": "OH",
            "license": "RN.462653",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "OH",
            "license": "APRN.CNP.0031362",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2024; 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.