NPIMap

Organization Active NPI

Random Lake Medical Center LLC

  • Family Medicine Physician
  • Random Lake, WI
National Provider Identifier
1285854240
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
39774 Issued in WI
Legal business name
RANDOM LAKE MEDICAL CENTER LLC
Practice address
N639 Silver Creek Cascade Road
Random Lake, WI 53075
Phone
(920) 994-9999
Fax
(920) 994-9998
NPI assigned
May 1, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Barbara A Weber, MDNPI 1437274925
Title
Owner
Phone
(920) 994-9999

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 39774 WI Primary

Addresses

Primary practice location

N639 Silver Creek Cascade Road
Random Lake, WI 53075

Mailing address

PO Box 246
N639 Silver Creek Cascade Rd
Random Lake, WI 53075
Phone (920) 994-9999

Other identifiers 1

IdentifierTypeStateIssuer
32420000MedicaidWI

National Provider Directory

National Provider Directory

Locations

675 Wolf Rd
Random Lake, WI 53075
Phone (920) 585-3922

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1285854240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 246",
            "address_2": "N639 SILVER CREEK CASCADE RD",
            "city": "RANDOM LAKE",
            "state": "WI",
            "postal_code": "53075",
            "telephone_number": "920-994-9999",
            "fax_number": "920-994-9998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N639 SILVER CREEK CASCADE ROAD",
            "city": "RANDOM LAKE",
            "state": "WI",
            "postal_code": "53075",
            "telephone_number": "920-994-9999",
            "fax_number": "920-994-9998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANDOM LAKE MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WEBER",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-994-9999",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "39774",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32420000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Random Lake, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.