Blake Randolph, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

35.129178 Issued in OH

Practice address

905 Old Diley Rd
Pickerington, OH 43147-2113

Phone

(740) 657-8000

NPI assigned

Mar 27, 2014

Last updated

Feb 6, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: blake.randolph.2@26020.direct.athenahealth.com
• Direct secure messaging: blake.randolph@pai.gwaydirect.com

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.

• Oh Independent Medical Group LLC

  • Family Medicine Physician
  • Columbus, OH
  • NPI 1497482111
  NPD (past)
• Pediatric Assoicates, Inc.

  • Pediatrics Physician
  • Canal Winchester, OH
  • NPI 1457346090
  NPD (past)

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

{
    "created_epoch": "1395878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738800000000",
    "number": "1285051144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 OLD DILEY RD",
            "city": "PICKERINGTON",
            "state": "OH",
            "postal_code": "431472113",
            "telephone_number": "614-864-3222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 OLD DILEY RD",
            "city": "PICKERINGTON",
            "state": "OH",
            "postal_code": "431472113",
            "telephone_number": "740-657-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "BLAKE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-27",
        "last_updated": "2025-02-06",
        "certification_date": "2025-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "35.129178",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tammy Rainey, NP
• Gabriella Anjilene Rainsburg
• Nirosha Rajendran
• Lisa Caroline Ramsey, PHD, NCC, LCPC
• Kedanna Marie Randle
• Connie Ray, RPH
• Brooke Reager
• Hannah Reager
• Meredith Reahm
• Anthony Recker, DPT

• Pediatrics Physician in Pickerington, OH
• Providers in Pickerington, OH by specialty
• Pediatrics Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.