Laura C. Randolph MD SC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

36100030 Issued in IL

Legal business name

LAURA C. RANDOLPH MD SC

Practice address

2502 E Empire St
Suite C
Bloomington, IL 61704-3738

Phone

(309) 664-6222

Fax

(309) 664-5006

NPI assigned

Sep 19, 2007

Last updated

Sep 19, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Rita Dempsey

Title

Office Manager

Phone

(309) 664-6222

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Laura C Randolph, M.D.

  • Plastic Surgery Physician
  • Bloomington, IL
  • NPI 1710906557
  Medicare reassignment NPD

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

{
    "created_epoch": "1190160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190160000000",
    "number": "1255527727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2502 E EMPIRE ST",
            "address_2": "SUITE C",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617043738",
            "telephone_number": "309-664-6222",
            "fax_number": "309-664-5006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2502 E EMPIRE ST",
            "address_2": "SUITE C",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617043738",
            "telephone_number": "309-664-6222",
            "fax_number": "309-664-5006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAURA C. RANDOLPH MD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-19",
        "last_updated": "2007-09-19",
        "status": "A",
        "authorized_official_last_name": "DEMPSEY",
        "authorized_official_first_name": "RITA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "309-664-6222"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "IL",
            "license": "36100030",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "097565",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH LINK",
            "identifier": "686867",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00193845",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "5732066",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heidi Larsen, MSW, LCSW
• Cheris Larson, LCSW
• Maribeth Lartz
• Sara Lary, DO
• Robert Lauder, DDS, MS
• Jamie Laurson
• Thomas Eric Laver, CRNA
• Kristine Lawless, PT
• Lawrence Nutrition Clinic LLC (Lawrence Nutrition Clinic)
• Javelin Monique Lawrence, CNSC

• Medical Specialty Clinic/Center in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Medical Specialty Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.