Randall Lee Proctor, M.D.

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

2016-02476 Issued in NC

Practice address

420 Spring Forest Rd
Greenville, NC 27834

Phone

(252) 752-4124

Fax

(252) 752-2044

NPI assigned

Jun 12, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Micrographic Dermatologic Surgery (MDS)

Education

Brody School of Medicine at East Carolina University, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eastern Dermatology PAGroup PAC ID 2860478542, 20 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

97.45 of 100Reported as group

Promoting interoperability

97

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Eastern Dermatology, P.a.

  • Dermatology Physician
  • Greenville, NC
  • NPI 1598759482

  Mohs-Micrographic Surgery

  Medicare reassignment Care Compare group NPD
• Eastern Dermatology PA

  • Dermatology Physician
  • Edenton, NC
  • NPI 1972715241
  NPD
• Cutaneous Oncology & Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Vestavia HLS, AL
  • NPI 1699139915
  NPD (past)

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

{
    "created_epoch": "1370995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533081600000",
    "number": "1366880304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 SPRING FOREST RD",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278342892",
            "telephone_number": "252-752-4124",
            "fax_number": "252-752-2044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 SPRING FOREST RD",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "27834",
            "telephone_number": "252-752-4124",
            "fax_number": "252-752-2044"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2100 Stantonsburg Rd",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "NC",
            "postal_code": "278342818",
            "country_code": "US",
            "telephone_number": "252-744-3229",
            "fax_number": "252-744-3924",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1940 Stonegate Dr Ste 130",
            "address_purpose": "LOCATION",
            "city": "Vestavia Hls",
            "state": "AL",
            "postal_code": "352422541",
            "country_code": "US",
            "telephone_number": "205-977-9876",
            "fax_number": "205-977-9976",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1940 Stonegate Dr Ste 130",
            "address_purpose": "LOCATION",
            "city": "Vestavia Hls",
            "state": "AL",
            "postal_code": "352422541",
            "country_code": "US",
            "telephone_number": "205-977-9876",
            "fax_number": "205-977-9976",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PROCTOR",
        "first_name": "RANDALL",
        "middle_name": "LEE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-12",
        "last_updated": "2018-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NC",
            "license": "2016-02476",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pro Worker Inc
• Hannah J Probst
• Alyssa Taylor Proctor, PA
• Berkley Proctor
• Elizabeth Proctor, PT, DPT
• Professional Business Group, Inc.
• Elena Mary Propst, MMS, MBA, PA-C
• Prosource Therapeutics LLC
• Anthony Provenzano
• Casaundra Camille Provenzano, MD

• MOHS-Micrographic Surgery Physician in Greenville, NC
• Providers in Greenville, NC by specialty
• MOHS-Micrographic Surgery Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2018; 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.

Verify at the official NPI Registry.