Active NPI
Breanna Joyce Ellen Randolph, PA-C
- Physician Assistant
- Houston, TX
National Provider Identifier
1336568690
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA09038
- Practice address
- 17270 Red Oak Dr
Suite 200
Houston, TX 77090-2618 - Phone
- (281) 440-6960
- Fax
- (281) 440-6205
- NPI assigned
- Apr 15, 2014
- Last updated
- Apr 15, 2014
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA09038 | TX | Primary |
Addresses
Primary practice location
17270 Red Oak Dr
Suite 200
Houston, TX 77090-2618
Mailing address
17270 Red Oak Dr
Suite 200
Houston, TX 77090-2618
Phone (281) 440-6960
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
3275 College Park Dr
The Woodlands, TX 77384-4501
Phone (346) 220-8063
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Organizations & group practices 1
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.
-
- Physical Medicine & Rehabilitation Physician
- The Woodlands, TX
- NPI 1457091027
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1397520000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1397520000000",
"number": "1336568690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17270 RED OAK DR",
"address_2": "SUITE 200",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770902618",
"telephone_number": "281-440-6960",
"fax_number": "281-440-6205"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17270 RED OAK DR",
"address_2": "SUITE 200",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770902618",
"telephone_number": "281-440-6960",
"fax_number": "281-440-6205"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDOLPH",
"first_name": "BREANNA",
"middle_name": "JOYCE ELLEN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-04-15",
"last_updated": "2014-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA09038",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2014; 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.