NPIMap

Individual provider Active NPI

Randal Paul Riesett, MD

  • Internal Medicine Physician
  • Marriottsville, MD
National Provider Identifier
1396738779
Registry record updated Nov 14, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
D0058747 Issued in MD
Practice address
2470 Longstone LN Ste I
Marriottsville, MD 21104-1523
Phone
(410) 910-2300
Fax
(410) 740-9134
NPI assigned
Aug 31, 2005
Last updated
Nov 14, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X D0058747 MD Primary

Addresses

Primary practice location

2470 Longstone LN Ste I
Marriottsville, MD 21104-1523

Mailing address

2470 Longstone LN Ste I
Marriottsville, MD 21104-1523
Phone (410) 910-2300

Other identifiers 2

IdentifierTypeStateIssuer
B6100007OtherDCBC/BS
512509000MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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
I20101202000136 MD Practitioner - Internal Medicine 5092901033 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Maryland School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Charter Internal Medicine, LLCGroup PAC ID 0244204113, 2 clinicians

Practice addresses (Care Compare)

2470 Longstone LN
Suite I
Marriottsville, MD 21104-1523
Phone (410) 910-2300

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Charter Internal Medicine, LLC Internal Medicine CurrentSince Jul 1, 2003 Accepting new patients
Windber Hospital, Inc. Past Accepting new patients

Locations

10700 Charter Dr
Ste 200
Columbia, MD 21044
Phone (410) 715-0108

2470 Longstone Ln
Ste I
Marriottsvl, MD 21104
Phone (410) 910-2300

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/23291/brand/1/csg/1/fhir/r4
  • Direct secure messaging: randal.riesett.1@23291.direct.athenahealth.com
  • Direct secure messaging: rriesett52844@direct.hopkinsmedicine.org

Organizations & group practices 2

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510617600000",
    "number": "1396738779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2470 LONGSTONE LN STE I",
            "city": "MARRIOTTSVILLE",
            "state": "MD",
            "postal_code": "211041523",
            "telephone_number": "410-910-2300",
            "fax_number": "410-740-9134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2470 LONGSTONE LN STE I",
            "city": "MARRIOTTSVILLE",
            "state": "MD",
            "postal_code": "211041523",
            "telephone_number": "410-910-2300",
            "fax_number": "410-740-9134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIESETT",
        "first_name": "RANDAL",
        "middle_name": "PAUL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-31",
        "last_updated": "2017-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D0058747",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "B6100007",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "512509000",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marriottsville, MD

Sources for this page

Verify at the official NPI Registry.