NPIMap

Individual provider Active NPI

Randall C Fedro, MD

  • Family Medicine Physician
  • Virginia Beach, VA
National Provider Identifier
1265443550
Registry record updated Oct 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0101037084 Issued in VA
Practice address
1232 Perimeter Pkwy
Suite 101
Virginia Beach, VA 23454-5924
Phone
(757) 425-8590
Fax
(757) 422-5107
NPI assigned
Aug 11, 2006
Last updated
Oct 26, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0101037084 VA Primary

Addresses

Primary practice location

1232 Perimeter Pkwy
Suite 101
Virginia Beach, VA 23454-5924

Mailing address

4211 Monarch Way 100
Norfolk, VA 23508-2540
Phone (757) 738-1400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080425000527 VA Practitioner - Family Practice 9537153812 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bayview Physician Services PCGroup PAC ID 5597664201, 311 clinicians

Practice addresses (Care Compare)

3235 Bridge Rd
Suite 15
Suffolk, VA 23435-1780
Phone (757) 606-1656

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Bayview Physician Services, PC Family Medicine CurrentSince Apr 15, 2019 Accepting new patients
Bayview Physician Services, PC CurrentSince Apr 15, 2019 Accepting new patients
Oceana Urgent Care and Family Practice Past Accepting new patients
Patient Choice Ghent Past Accepting new patients

Locations

111 Mill Creek Pkwy
Chesapeake, VA 23323
Phone (757) 558-8210

3241 Western Branch Blvd
Chesapeake, VA 23321
Phone (757) 686-3500

3241 Western Branch Blvd
Ste A
Chesapeake, VA 23321

3235 Bridge Rd
Ste 15
Suffolk, VA 23435
Phone (757) 606-1656

4868 Bridge Rd
Ste 300
Suffolk, VA 23435
Phone (757) 483-7100

Interoperability endpoints

  • Direct secure messaging: randall.fedro@bayview.eclinicaldirectplus.com

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.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445817600000",
    "number": "1265443550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4211 MONARCH WAY 100",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235082540",
            "telephone_number": "757-738-1400",
            "fax_number": "757-489-3092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1232 PERIMETER PKWY",
            "address_2": "SUITE 101",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234545924",
            "telephone_number": "757-425-8590",
            "fax_number": "757-422-5107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEDRO",
        "first_name": "RANDALL",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-11",
        "last_updated": "2015-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101037084",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia Beach, VA

Sources for this page

Verify at the official NPI Registry.