NPIMap

Individual provider Active NPI

Milton Gregory Randall, P.T.

  • Physical Therapist
  • Show Low, AZ
National Provider Identifier
1255376240
Registry record updated Sep 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
6094 Issued in AZ
Practice address
5171 Cub Lake Rd.
Suite C 360
Show Low, AZ 85901-7823
Phone
(928) 537-0248
Fax
(928) 537-0251
NPI assigned
Jun 17, 2006
Last updated
Sep 16, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 6094 AZ Primary
Geriatric Physical Therapist 2251G0304X 6094 AZ
Orthopedic Physical Therapist 2251X0800X 6094 AZ

Addresses

Primary practice location

5171 Cub Lake Rd.
Suite C 360
Show Low, AZ 85901-7823

Mailing address

PO Box 457
Show Low, AZ 85902-0457
Phone (928) 207-6873

Other names 1

  • M Gregor Randall Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051021000438 AZ Practitioner - Physical Therapist in Private Practice 3577589266 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alpha and Omega Physical Therapy AccGroup PAC ID 3072506120, 2 clinicians

Practice addresses (Care Compare)

861 E Cooley St B
Show Low, AZ 85901-5121
Phone (928) 537-2678

Merit-based Incentive Payment System (MIPS)

Final score
22.03 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
73.44

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6094AZMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Alpha and Omega Physical Therapy Acc Physical Therapist CurrentSince Aug 4, 2015 Accepting new patients
Alpha and Omega Physical Therapy Acc Physical Therapist CurrentSince Aug 4, 2015 Accepting new patients
New Horizons Physical Therapy, LTD. PastSince Mar 1, 2001 Accepting new patients

Locations

861 E Cooley St
#B
Show Low, AZ 85901
Phone (928) 522-0364

861 E Cooley St
Ste B
Show Low, AZ 85901
Phone (928) 207-6873

Organizations & group practices 4

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": "1150502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442361600000",
    "number": "1255376240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 457",
            "city": "SHOW LOW",
            "state": "AZ",
            "postal_code": "859020457",
            "telephone_number": "928-207-6873",
            "fax_number": "866-762-2534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5171 CUB LAKE RD.",
            "address_2": "SUITE C 360",
            "city": "SHOW LOW",
            "state": "AZ",
            "postal_code": "859017823",
            "telephone_number": "928-537-0248",
            "fax_number": "928-537-0251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDALL",
        "first_name": "MILTON",
        "middle_name": "GREGORY",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-17",
        "last_updated": "2015-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "6094",
            "primary": true
        },
        {
            "code": "2251G0304X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Geriatrics",
            "state": "AZ",
            "license": "6094",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "AZ",
            "license": "6094",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "M",
            "last_name": "RANDALL",
            "middle_name": "GREGOR",
            "credential": "P.T.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Show Low, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.