Lisa Marie Randon, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

4301068207 Issued in MI

Practice address

2395 W Grand Blvd
Detroit, MI 48208-1210

Phone

(313) 831-2442

Fax

(313) 831-2442

NPI assigned

Feb 9, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Miss Lisa Marie Harrell Former name

Medicare fee-for-service enrollment

Enrolled in MI

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

Interoperability endpoints

• Direct secure messaging: lisa.randon@dchc.directbygreenway.com
• Direct secure messaging: lrandon@direct.dmc.org

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

• Detroit Community Health Connection, Inc.

  • Federally Qualified Health Center (FQHC)
  • Detroit, MI
  • NPI 1982611562
  Medicare reassignment NPD
• Lisa M Randon MD LLC

  • Pediatrics Physician
  • Detroit, MI
  • NPI 1699295659
  Authorized official Same address or phone
• Detroit Community Health Connection, Inc

  dba Dr. Peter Slaughter Health Center

  • Federally Qualified Health Center (FQHC)
  • Detroit, MI
  • NPI 1588137376
  NPD
• City of Detroit

  dba Detroit Health Department

  • Public Health or Welfare Agency
  • Detroit, MI
  • NPI 1033429394
  NPD (past)
• Detroit Health Care for the Homeless

  dba Advantage Health

  • Federally Qualified Health Center (FQHC)
  • Warren, MI
  • NPI 1043103989
  NPD (past)
• Professional Plaza Clinic Corporation

  • Legal Medicine
  • Detroit, MI
  • NPI 1992709331
  NPD (past)

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487030400000",
    "number": "1316088644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1511 BROOKLYN ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482261007",
            "telephone_number": "313-608-1510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2395 W GRAND BLVD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482081210",
            "telephone_number": "313-831-2442",
            "fax_number": "313-831-2442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDON",
        "first_name": "LISA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-09",
        "last_updated": "2017-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301068207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "HARRELL",
            "middle_name": "MARIE",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Felicia R. Randolph, MD
• Isabel A Randolph, MD
• Jazmine S Randolph
• La'Shunti Randolph, LLMSW
• Tonia Denise Randolph
• Randys Place LLC
• Elizabeth Anne Ranella, CRNA
• Louis Anthony Ranella, CRNA
• Kiran P Ranganath, B.D.S., M.P.H
• Poornima Ranganathan, MD

• Pediatrics Physician in Detroit, MI
• Providers in Detroit, MI by specialty
• Pediatrics Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2017; 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.