Randal John Lewis, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

6901924-1205 Issued in UT

Practice address

310 E 4500 S Ste 410
Murray, UT 84107-3993

Phone

(801) 850-2800

NPI assigned

Jun 26, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in UT

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: adultcareclinic.randallewismd@133918.advancedmd-direct.com

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.

• Signify Health, LLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1689158487

  UT

  Medicare reassignment NPD

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596326400000",
    "number": "1215964309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1082 N 1000 W",
            "city": "AMERICAN FORK",
            "state": "UT",
            "postal_code": "840033897",
            "telephone_number": "801-850-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 E 4500 S STE 410",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841073993",
            "telephone_number": "801-850-2800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3665 S 8400 W",
            "address_2": "Suite 110",
            "address_purpose": "LOCATION",
            "city": "Magna",
            "state": "UT",
            "postal_code": "840444907",
            "country_code": "US",
            "telephone_number": "801-250-9638",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "RANDAL",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-26",
        "last_updated": "2020-08-02",
        "certification_date": "2020-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "",
            "desc": "Legal Medicine",
            "state": "NM",
            "license": "89-246",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "6901924-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "E2139",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA PROVIDER NUMBER",
            "identifier": "002400968",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER  NUMBER",
            "identifier": "4468903",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cody-Ryan Lewis
• Elvina Lewis
• Haley Romberger Lewis, CSW
• Isabel Lewis, OTR/L
• Mark Andrew Lewis, M.D.
• Shane D. Lewis, M.D.
• Liberty Drug
• Lice Clinic of America Murray
• Lifestar
• Lifestar Salt Lake, LLC

• Family Medicine Physician in Murray, UT
• Providers in Murray, UT by specialty
• Family Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.