NPIMap

Individual provider Active NPI

Randall S Zuckerman, M.D.

  • Surgery Physician
  • Kalispell, MT
National Provider Identifier
1265496947
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
42017 Issued in MT
Practice address
1333 Surgical Services Way
Kalispell, MT 59901-4844
Phone
(406) 751-5392
NPI assigned
Apr 12, 2006
Last updated
Nov 27, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 42017 MT Primary

Addresses

Primary practice location

1333 Surgical Services Way
Kalispell, MT 59901-4844

Mailing address

1333 Surgical Services Way
Kalispell, MT 59901-4844
Phone (406) 751-5392

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address krmcmedicalrecords@krhdirect.org Kalispell Regional Medical Center Inc

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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
I20220909002865 NV Practitioner - General Surgery 1759459639 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Care Services LLCGroup PAC ID 1951324318, 630 clinicians

Practice addresses (Care Compare)

1500 E 2ND St
Suite 300
Reno, NV 89502-1198
Phone (775) 982-5000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
42017MTMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Care Services LLC CurrentSince May 28, 2022 Accepting new patients
Community Care Services LLC Current Accepting new patients
Community Care Services LLC CurrentSince May 28, 2022 Accepting new patients
Saint Raphael Healthcare System Affiliated Physicians Inc Surgery Past Accepting new patients
North Country Hospital & Health Center Inc Past Accepting new patients
Saint Raphael Faculty Physicians Surgery Past Accepting new patients
SVMC Holdings, Inc Past Accepting new patients
Community Care Services LLC Past Accepting new patients

Locations

10315 Professional Cir
Reno, NV 89521
Phone (775) 982-5860

1500 E 2nd St
Ste 300
Reno, NV 89502
Phone (775) 322-7811

Interoperability endpoints

  • Direct secure messaging: rzuckerman186723@direct.renown.org

Organizations & group practices 8

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 3

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": "1144800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1265496947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1333 SURGICAL SERVICES WAY",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599014844",
            "telephone_number": "406-751-5392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1333 SURGICAL SERVICES WAY",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599014844",
            "telephone_number": "406-751-5392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZUCKERMAN",
        "first_name": "RANDALL",
        "middle_name": "S",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-12",
        "last_updated": "2023-11-27",
        "certification_date": "2020-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MT",
            "license": "42017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "krmcmedicalrecords@krhdirect.org",
            "affiliation": "Y",
            "affiliationName": "Kalispell Regional Medical Center Inc",
            "address_1": "1333 Surgical Services Way",
            "city": "Kalispell",
            "state": "MT",
            "country_code": "US",
            "postal_code": "599014844",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kalispell, MT

Sources for this page

Verify at the official NPI Registry.