Jeremiah Scott Randall, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

8527 Issued in MN

Practice address

841 Forest Ave E Ste 210
Mora, MN 55051-5501

Phone

(320) 244-2451

NPI assigned

Feb 2, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Serenity Behavioral Health and Wellness, LLCGroup PAC ID 7810308517, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Serenity Behavioral Health & Wellness LLC

  • Clinical Psychologist
  • Savage, MN
  • NPI 1750999546

  MN

  Medicare reassignment Care Compare group NPD
• East Central Behavioral Health LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Mora, MN
  • NPI 1194421255

  Psychiatric/Mental Health

  NPD Authorized official

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

{
    "created_epoch": "1612224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730246400000",
    "number": "1407447246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 202",
            "city": "OGILVIE",
            "state": "MN",
            "postal_code": "563580202",
            "telephone_number": "320-223-0467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "841 FOREST AVE E STE 210",
            "city": "MORA",
            "state": "MN",
            "postal_code": "550515501",
            "telephone_number": "320-244-2451"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6375 W 143rd St",
            "address_purpose": "LOCATION",
            "city": "Savage",
            "state": "MN",
            "postal_code": "553782888",
            "country_code": "US",
            "telephone_number": "952-592-2200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RANDALL",
        "first_name": "JEREMIAH",
        "middle_name": "SCOTT",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-02-02",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "8527",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Lynn Peterson
• Shane Peterson
• Susan R Peterson
• Playful Healing, LLC
• Natalie Ann Radich
• Karen K Rasmusson, NP
• Recovering Hope Treatment Center LLC
• Recovering Hope Treatment Center, Inc.
• Recovering Hope Treatment Center, Inc.
• Emily Richardson, ATC

• All providers in Mora, MN
• Psychiatric/Mental Health Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2024; 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.