Active NPI
Brittany Randolph
- Counselor
- Park Ridge, IL
National Provider Identifier
1396093639
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 819 Busse Hwy
Park Ridge, IL 60068-2360 - Phone
- (847) 696-1570
- NPI assigned
- Aug 16, 2012
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | Primary |
Addresses
Primary practice location
819 Busse Hwy
Park Ridge, IL 60068-2360
Mailing address
5256 Imperial Dr
Richton Park, IL 60471-1552
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)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Maine Center, Inc. | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Park Ridge, IL
- NPI 1518087188
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1345075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1345075200000",
"number": "1396093639",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5256 IMPERIAL DR",
"city": "RICHTON PARK",
"state": "IL",
"postal_code": "604711552"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "819 BUSSE HWY",
"city": "PARK RIDGE",
"state": "IL",
"postal_code": "600682360",
"telephone_number": "847-696-1570"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDOLPH",
"first_name": "BRITTANY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-08-16",
"last_updated": "2012-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Park Ridge, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 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.