Active NPI
Randall Douglas McClellan, MD
- Pediatric Gastroenterology Physician
- Huntsville, AL
National Provider Identifier
1255349775
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Gastroenterology Physician
- License
- 00024549
- Practice address
- 303 Williams Avenue
Suite 1021
Huntsville, AL 35801 - Phone
- (256) 536-3832
- Fax
- (256) 536-8829
- NPI assigned
- Aug 3, 2006
- 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 |
|---|---|---|---|---|
| Pediatric Gastroenterology Physician | 2080P0206X | 00024549 | AL | Primary |
Addresses
Primary practice location
303 Williams Avenue
Suite 1021
Huntsville, AL 35801
Mailing address
303 Williams Avenue
Suite 1021
Huntsville, AL 35801
Phone (256) 536-3832
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00937065 | Medicaid | AL | |
| 51516878 | Other | AL | BC |
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00024549 | AL | MD | Pediatric Gastroenterology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pediatric Gastroenterology Associates PC | Pediatric Gastroenterology | Past | Accepting new patients |
| The Health Care Authority of the City of Huntsville | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Pediatric Gastroenterology Physician
- Huntsville, AL
- NPI 1407969371
-
- General Acute Care Hospital
- Huntsville, AL
- NPI 1447221056
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1255349775",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "303 WILLIAMS AVENUE",
"address_2": "SUITE 1021",
"city": "HUNTSVILLE",
"state": "AL",
"postal_code": "35801",
"telephone_number": "256-536-3832",
"fax_number": "256-536-8829"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "303 WILLIAMS AVENUE",
"address_2": "SUITE 1021",
"city": "HUNTSVILLE",
"state": "AL",
"postal_code": "35801",
"telephone_number": "256-536-3832",
"fax_number": "256-536-8829"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCLELLAN",
"first_name": "RANDALL",
"middle_name": "DOUGLAS",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0206X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Gastroenterology",
"state": "AL",
"license": "00024549",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00937065",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC",
"identifier": "51516878",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Huntsville, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.