Active NPI
Teddy Randall
- Marriage & Family Therapist
- Panama City, FL
National Provider Identifier
1225484389
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- Practice address
- 2711 W 15TH St
Panama City, FL 32401-1366 - Phone
- (850) 769-6001
- NPI assigned
- May 9, 2016
- Last updated
- May 9, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | Primary |
Addresses
Primary practice location
2711 W 15TH St
Panama City, FL 32401-1366
Mailing address
16 Pebble Beach Dr
Shalimar, FL 32579-1624
Other names 1
- Ted Randall
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jun 17, 2024 through Jun 17, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1462752000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1462752000000",
"number": "1225484389",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16 PEBBLE BEACH DR",
"city": "SHALIMAR",
"state": "FL",
"postal_code": "325791624"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2711 W 15TH ST",
"city": "PANAMA CITY",
"state": "FL",
"postal_code": "324011366",
"telephone_number": "850-769-6001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDALL",
"first_name": "TEDDY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-05-09",
"last_updated": "2016-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "TED",
"last_name": "RANDALL",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Panama City, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.