NPIMap

Individual provider Active NPI

Randall Lee Martin, MD

  • Anesthesiology Physician
  • Laramie, WY
National Provider Identifier
1215955885
Registry record updated May 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
60771584 Issued in WA
Practice address
204 McCollum Drive
Suite 101
Laramie, WY 82070
Phone
(307) 745-6065
Fax
(307) 745-4936
NPI assigned
Jul 18, 2006
Last updated
May 15, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X MD14891 OR
Anesthesiology Physician 207L00000X TL1962 WY
Anesthesiology Physician 207L00000X 60771584 WA Primary

Addresses

Primary practice location

204 McCollum Drive
Suite 101
Laramie, WY 82070

Mailing address

22187 SE Lafayette Hwy
Dayton, OR 97114-8818
Phone (503) 868-7770

Other identifiers 2

IdentifierTypeStateIssuer
176917MedicaidOR
200948040MedicaidIN

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)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD14891ORMDAnesthesiology Physician
60771584WAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Oregon Anesthesiology Group PC Anesthesiology PastSince Jul 25, 2019 Accepting new patients
Anesthesia Associates of Laramie LLC Anesthesiology Past Accepting new patients
High Plains General Surgery Inc Past Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526342400000",
    "number": "1215955885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22187 SE LAFAYETTE HWY",
            "city": "DAYTON",
            "state": "OR",
            "postal_code": "971148818",
            "telephone_number": "503-868-7770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 MCCOLLUM DRIVE",
            "address_2": "SUITE 101",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "82070",
            "telephone_number": "307-745-6065",
            "fax_number": "307-745-4936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "RANDALL",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2018-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OR",
            "license": "MD14891",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WY",
            "license": "TL1962",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WA",
            "license": "60771584",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "176917",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200948040",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laramie, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2018; 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.