Individual provider Active NPI

Lisbeth Ann Randall, DDS

  • Dentist
  • Fishers, IN
National Provider Identifier
1235248469
Registry record updated Nov 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
12009343 Issued in IN
Practice address
9931 Eller Rd
Fishers, IN 46038
Phone
(317) 578-2533
Fax
(317) 578-2433
NPI assigned
Aug 30, 2006
Last updated
Nov 10, 2010By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 10, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 12009343 IN Primary

Addresses

Primary practice location

9931 Eller Rd
Fishers, IN 46038

Mailing address

9931 Eller Rd
Fishers, IN 46038
Phone (317) 578-2533

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160720001703 IN Order and Referring Only - DentistPractitioner - Dentist 2264725829

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12009343INMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289347200000",
    "number": "1235248469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9931 ELLER RD",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "46038",
            "telephone_number": "317-578-2533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9931 ELLER RD",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "46038",
            "telephone_number": "317-578-2533",
            "fax_number": "317-578-2433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDALL",
        "first_name": "LISBETH",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2010-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12009343",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fishers, IN

Sources for this page

Verify at the official NPI Registry.