Active NPI
Randall Wayne Toothaker, D.D.S.
- Dentist
- Fort Dodge, IA
National Provider Identifier
1295817518
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(3) exclusion effective Oct 20, 2015.
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DDS-09060
- Practice address
- 328 Country Club Drive
Fort Dodge, IA 50501 - Phone
- (515) 302-8079
- NPI assigned
- Oct 19, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DDS-09060 | IA | Primary |
Addresses
Primary practice location
328 Country Club Drive
Fort Dodge, IA 50501
Mailing address
328 Country Club Drive
Fort Dodge, IA 50501
Phone (515) 302-8079
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5287 | Other | NE | BC/BS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DDS-09060 | IA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1428019200000",
"number": "1295817518",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "328 COUNTRY CLUB DRIVE",
"city": "FORT DODGE",
"state": "IA",
"postal_code": "50501",
"telephone_number": "515-302-8079"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "328 COUNTRY CLUB DRIVE",
"city": "FORT DODGE",
"state": "IA",
"postal_code": "50501",
"telephone_number": "515-302-8079"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TOOTHAKER",
"first_name": "RANDALL",
"middle_name": "WAYNE",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-19",
"last_updated": "2015-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IA",
"license": "DDS-09060",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS",
"identifier": "5287",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Dodge, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.