Randolph R Evans, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

18805 Issued in TN

Practice address

1670 W Main St
Ste100
Lebanon, TN 37087-1344

Phone

(615) 453-5155

Fax

(615) 444-5915

NPI assigned

Jul 8, 2005

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

Other identifiers 10

Medicare fee-for-service enrollment

Enrolled in TN

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

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Vanderbilt University Medical Center

  • Internal Medicine Physician
  • Nashville, TN
  • NPI 1104202761

  Ophthalmology

  Medicare reassignment NPD
• Lebanon Eye Associates

  • Durable Medical Equipment & Medical Supplies
  • Lebanon, TN
  • NPI 1386857647
  NPD (past)

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

{
    "created_epoch": "1120780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1345161600000",
    "number": "1295733772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1670 W MAIN ST",
            "address_2": "STE100",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370871344",
            "telephone_number": "615-453-5155",
            "fax_number": "615-444-5915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1670 W MAIN ST",
            "address_2": "STE100",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370871344",
            "telephone_number": "615-453-5155",
            "fax_number": "615-444-5915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "RANDOLPH",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-08",
        "last_updated": "2012-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "TN",
            "license": "18805",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO",
            "identifier": "4065401",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "1238610001",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA",
            "identifier": "180006421",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS ADVANTAGE",
            "identifier": "000089791",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHSPRING",
            "identifier": "3032849",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000089791",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3389788",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEFAULT",
            "identifier": "621298175",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TENNCARE SELECT",
            "identifier": "000089791",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VISION SERVICE PLAN",
            "identifier": "186641053",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Desiree Ellison, FNP-C
• Employment & Assessment Solutions, Inc.
• Employment and Assessment Solutions, Inc.
• Savannah Enoch, OTR/L
• Gretchen Dene Etheredge, PT
• Donald O. Ezuteh, M.D.
• Kathy Fahner
• La Keisha Fair, MAE, ATC,LAT
• Family Eye Med, PLLC
• Family Medical Community Healthcare, PLLC

• Ophthalmology Physician in Lebanon, TN
• Providers in Lebanon, TN by specialty
• Ophthalmology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2012; 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.