Randall Dean Staley Jr., MD

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

E-6379 Issued in AR

Practice address

4700 S Thompson St Ste C103
Springdale, AR 72764

Phone

(479) 571-6363

Fax

(479) 684-3941

NPI assigned

Dec 11, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AR

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

Specialty

Psychiatry

Education

University of Arkansas College of Medicine, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Medical Associates of Northwest Arkansas, PA 102 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: randall.staley@mana.eclinicaldirectplus.com

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.

• Medical Associates of Northwest Arkansas, PA

  • Internal Medicine Physician
  • Fayetteville, AR
  • NPI 1801847827

  AR, Psychiatry

  Medicare reassignment Care Compare group NPD
• Medical Associates of Northwest Arkansas PA

  • Podiatrist
  • Fayetteville, AR
  • NPI 1164140729
  Care Compare group NPD (past)
• Medical Associates of Northwest Arkansas PA

  • Pediatrics Physician
  • Rogers, AR
  • NPI 1497190797

  Pediatrics

  NPD
• Medical Associates of Northwest Arkansas PA

  • Family Medicine Physician
  • Lowell, AR
  • NPI 1912883273
  NPD
• Medical Associates of Northwest Arkansas PA

  • Family Medicine Physician
  • Fayetteville, AR
  • NPI 1710218995

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1197331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723680000000",
    "number": "1295918449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1523",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727021523",
            "telephone_number": "479-571-6038",
            "fax_number": "479-582-0222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 S THOMPSON ST STE C103",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "72764",
            "telephone_number": "479-571-6363",
            "fax_number": "479-684-3941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STALEY",
        "first_name": "RANDALL",
        "middle_name": "DEAN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-12-11",
        "last_updated": "2024-08-15",
        "certification_date": "2024-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "AR",
            "license": "E-6379",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "AR",
            "license": "E-6379",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "E6379",
            "state": "AR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "randall.staley@mana.eclinicaldirectplus.com",
            "affiliation": "N",
            "endpointDescription": "randall.staley@mana.eclinicaldirectplus.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "4700 S Thompson St Ste C103",
            "city": "Springdale",
            "state": "AR",
            "country_code": "US",
            "postal_code": "72764",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jeanine Stable, RN
• Michelle Hand Stacy, SLP
• Alyssa Ann Stafford
• Shannon M Staggs, APRN
• Rebecca Katherine Stalder, PT, DPT
• Casandra N Stamps, LCSW
• Josef Stamps
• Peyton E Standefer, CNIM
• Brooke Marie Standridge, MS, CCC- SLP
• Cassie Stanley

• All providers in Springdale, AR
• Child & Adolescent Psychiatry Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.