NPIMap

Individual provider Active NPI

Glynnis D Randall, F.N.P.

  • Nurse Practitioner
  • Wiggins, MS
National Provider Identifier
1346355583
Registry record updated Nov 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
R764278 Issued in MS
Practice address
975 Hall St
Wiggins, MS 39577-2107
Phone
(601) 528-9119
Fax
(601) 528-9193
NPI assigned
Aug 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X R764278 MS Primary

Addresses

Primary practice location

975 Hall St
Wiggins, MS 39577-2107

Mailing address

PO Box 1007
Lucedale, MS 39452-1007
Phone (601) 947-1332

Other identifiers 1

IdentifierTypeStateIssuer
0116288MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040527000304 MS Practitioner - Nurse Practitioner 4183605967 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorial Hospital at GulfportGroup PAC ID 2466524012, 473 clinicians

Practice addresses (Care Compare)

1110 Broad Ave
Suite 700
Gulfport, MS 39501-8908
Phone (228) 864-0314

Hospital & facility affiliations

  • Deaconess Homecare- Region I Home health agency, Laurel, MS, CCN 257085
  • Memorial Hospital at Gulfport Hospital, Gulfport, MS, CCN 250019

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R764278MSMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital at Gulfport Nurse Practitioner CurrentSince Dec 12, 2024 Accepting new patients
Wiggins Primary Care CurrentSince Sep 12, 2010 Accepting new patients
Memorial Hospital at Gulfport Current Accepting new patients
Heartsouth PLLC Nurse Practitioner Past Accepting new patients
Memorial Hospital at Gulfport Past Accepting new patients
George Regional Radiology PastSince Sep 12, 2010 Accepting new patients

Locations

4333 15th St
#A
Gulfport, MS 39501
Phone (228) 324-2363

1340 Broad Ave
Ste 440
Gulfport, MS 39501
Phone (228) 867-4856

1110 Broad Ave
Ste 700
Gulfport, MS 39501
Phone (228) 864-0314

975 Hall St
Wiggins, MS 39577
Phone (601) 528-9119

Interoperability endpoints

  • Direct secure messaging: glynnisrandall@communitym.allscriptsdirect.net
  • FHIR API: https://api.platform.athenahealth.com/2667/brand/1/csg/1/fhir/r4

Organizations & group practices 7

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 61

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

View all 61

NPI Registry JSON

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479772800000",
    "number": "1346355583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1007",
            "city": "LUCEDALE",
            "state": "MS",
            "postal_code": "394521007",
            "telephone_number": "601-947-1332",
            "fax_number": "601-947-1331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "975 HALL ST",
            "city": "WIGGINS",
            "state": "MS",
            "postal_code": "395772107",
            "telephone_number": "601-528-9119",
            "fax_number": "601-528-9193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDALL",
        "first_name": "GLYNNIS",
        "middle_name": "D",
        "name_prefix": "Mrs.",
        "credential": "F.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-20",
        "last_updated": "2016-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "R764278",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0116288",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wiggins, MS

Sources for this page

Verify at the official NPI Registry.