Active NPI
Erin Michelle Randall, MS,
- Athletic Trainer
- Marengo, IL
National Provider Identifier
1306814819
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 212 Lindow LN Ste M
Marengo, IL 60152-9480 - Phone
- (815) 568-6511
- NPI assigned
- Mar 9, 2006
- Last updated
- Sep 11, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | IL | Primary |
Addresses
Primary practice location
212 Lindow LN Ste M
Marengo, IL 60152-9480
Mailing address
921 Village CT
Marengo, IL 60152-3638
Phone (815) 572-5001
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 096-001943 | IL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141862400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1189468800000",
"number": "1306814819",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "921 VILLAGE CT",
"city": "MARENGO",
"state": "IL",
"postal_code": "601523638",
"telephone_number": "815-572-5001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "212 LINDOW LN STE M",
"city": "MARENGO",
"state": "IL",
"postal_code": "601529480",
"telephone_number": "815-568-6511"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDALL",
"first_name": "ERIN",
"middle_name": "MICHELLE",
"name_prefix": "Mrs.",
"credential": "MS,",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-03-09",
"last_updated": "2007-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marengo, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.