Active NPI
John Carl Randall, LMSW
- Social Worker
- Boise, ID
National Provider Identifier
1386906436
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- LMSW-32190
- Practice address
- 2273 S Vista Ave
Ste 190
Boise, ID 83705-7341 - Phone
- (208) 343-2737
- Fax
- (208) 342-3238
- NPI assigned
- Jun 14, 2012
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | LMSW-32190 | ID | Primary |
Addresses
Primary practice location
2273 S Vista Ave
Ste 190
Boise, ID 83705-7341
Mailing address
3132 W Irene St
Boise, ID 83703-5874
Phone (315) 278-6609
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LMSW-32190 | ID | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339632000000",
"number": "1386906436",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3132 W IRENE ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837035874",
"telephone_number": "315-278-6609"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2273 S VISTA AVE",
"address_2": "STE 190",
"city": "BOISE",
"state": "ID",
"postal_code": "837057341",
"telephone_number": "208-343-2737",
"fax_number": "208-342-3238"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDALL",
"first_name": "JOHN",
"middle_name": "CARL",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-06-14",
"last_updated": "2012-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "ID",
"license": "LMSW-32190",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.