Randy Scott Breidel, SUB IDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

Dam Neck Annex
1885 Terrier Ave Ste 100
Virginia Beach, VA 23461-2298

Phone

(757) 314-7221

NPI assigned

Mar 16, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1142467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1265401673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "761 DWYER RD",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234546924",
            "telephone_number": "757-689-8742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "DAM NECK ANNEX",
            "address_2": "1885 TERRIER AVE STE 100",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234612298",
            "telephone_number": "757-314-7221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BREIDEL",
        "first_name": "RANDY",
        "middle_name": "SCOTT",
        "name_prefix": "Mr.",
        "credential": "SUB IDC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-16",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Virginia Beach, VA
• Independent Duty Corpsman in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.