Individual provider Active NPI

Tanteria Randolph, FNP-BC

  • Family Nurse Practitioner
  • Camp Hill, PA
National Provider Identifier
1326501883
Registry record updated Feb 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
SP019917 Issued in PA
Practice address
890 Poplar Church Rd Ste 100
Camp Hill, PA 17011-2250
Phone
(717) 737-3465
NPI assigned
Apr 11, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R242989 MD
Family Nurse Practitioner 363LF0000X SP019917 PA Primary

Addresses

Primary practice location

890 Poplar Church Rd Ste 100
Camp Hill, PA 17011-2250

Mailing address

890 Poplar Church Rd Ste 100
Camp Hill, PA 17011-2250
Phone (717) 737-3465

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190711001418 PA Practitioner - Nurse Practitioner 9335474410 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Penn State Health Medical Group LLCGroup PAC ID 8729351077, 720 clinicians

Practice addresses (Care Compare)

890 Poplar Church Rd
Camp Hill, PA 17011-2250
Phone (717) 737-3465

Hospital & facility affiliations

  • Penn State Health Holy Spirit Medical Center Hospital, Camp Hill, PA, CCN 390004
  • Penn State Health St. Joseph Hospital, Reading, PA, CCN 390096
  • Milton S Hershey Medical Center Hospital, Hershey, PA, CCN 390256

Merit-based Incentive Payment System (MIPS)

Final score
82.85 of 100Reported as group
Quality
65.84
Promoting interoperability
100
Improvement activities
40
Cost
77

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R242989MDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Penn State Health Medical Group, LLC CurrentSince Oct 2, 2023 Accepting new patients
Penn State Health Medical Group, LLC Family CurrentSince Oct 2, 2023 Accepting new patients
Penn State Health Medical Group, LLC Current Accepting new patients
Penn State Health Medical Group, LLC Past Accepting new patients

Locations

423 N 21st St
Ste 202
Camp Hill, PA 17011
Phone (717) 763-9880

890 Poplar Church Rd
Ste 100
Camp Hill, PA 17011
Phone (717) 737-3465

1800 Center St
Ste 1A110
Camp Hill, PA 17011
Phone (717) 775-5093

1211 Forge Rd
Ste 300
Carlisle, PA 17013
Phone (717) 218-3920

2850 Commerce Dr
Ste 200A
Harrisburg, PA 17110
Phone (717) 901-9898

1120 Cocoa Ave
Hershey, PA 17033
Phone (717) 533-4141

Organizations & group practices 4

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1554940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738540800000",
    "number": "1326501883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "890 POPLAR CHURCH RD STE 100",
            "city": "CAMP HILL",
            "state": "PA",
            "postal_code": "170112250",
            "telephone_number": "717-737-3465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "890 POPLAR CHURCH RD STE 100",
            "city": "CAMP HILL",
            "state": "PA",
            "postal_code": "170112250",
            "telephone_number": "717-737-3465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "TANTERIA",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-11",
        "last_updated": "2025-02-03",
        "certification_date": "2025-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R242989",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP019917",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Camp Hill, PA

Sources for this page

Verify at the official NPI Registry.