Randy Charles Hancock, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

3297 Issued in AZ

Practice address

19251 E Oasis Dr
Black Canyon City, AZ 85324-8878

Phone

(623) 374-0200

Fax

(623) 374-5576

NPI assigned

Jan 19, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

At Still University of Health Sciences, College of Osteo Med, Kirksville, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Black Canyon Community Health Center IncGroup PAC ID 6406900331, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Abrazo Arrowhead Hospital Hospital, Glendale, AZ, CCN 030094

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/16465/brand/1/csg/1/fhir/r4
• Direct secure messaging: randy.hancock.1@16465.direct.athenahealth.com

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Black Canyon Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Mayer, AZ
  • NPI 1124730627

  Corporate Officer

  CMS ownership
• Black Canyon Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Black Canyon City, AZ
  • NPI 1992438642

  Corporate Officer

  CMS ownership

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.

• Black Canyon Community Health Center, Inc.

  • Family Medicine Physician
  • Black Canyon City, AZ
  • NPI 1679723217
  Medicare reassignment Care Compare group NPD Authorized official
• Black Canyon Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Mayer, AZ
  • NPI 1124730627

  Family Medicine

  NPD Authorized official
• New River Family Medicine L.L.C.

  • Family Medicine Physician
  • New River, AZ
  • NPI 1982890851
  NPD (past) Authorized official

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

• VHS of Arrowhead, Inc

  • General Acute Care Hospital
  • Glendale, AZ
  • NPI 1326022765
  Care Compare affiliation
• VHS of Arrowhead, Inc.

  • General Acute Care Hospital
  • Peoria, AZ
  • NPI 1801340781
  Care Compare affiliation

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

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671148800000",
    "number": "1467432971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1958",
            "city": "BLACK CANYON CITY",
            "state": "AZ",
            "postal_code": "853241958",
            "telephone_number": "623-374-0200",
            "fax_number": "623-374-5576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19251 E OASIS DR",
            "city": "BLACK CANYON CITY",
            "state": "AZ",
            "postal_code": "853248878",
            "telephone_number": "623-374-0200",
            "fax_number": "623-374-5576"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17301 E Spring Valley Rd Ste F",
            "address_purpose": "LOCATION",
            "city": "Mayer",
            "state": "AZ",
            "postal_code": "863334263",
            "country_code": "US",
            "telephone_number": "623-374-0200",
            "fax_number": "623-374-5576",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HANCOCK",
        "first_name": "RANDY",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-19",
        "last_updated": "2022-12-16",
        "certification_date": "2022-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "3297",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "445917",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "Z131033",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Black Canyon Physical Therapy, PLLC
• Marci Brown-Gilpin, LCSW
• Canon Elementary School District
• Canyon Medical Clinic LLC
• Emd Medical Services LLC
• Home Health Services, PLLC
• Andrea Kay Irving, D.O.
• Paw Kamwee, N.M.D
• Joshua Cheol-Hong Kim, D.O.
• Elli Klinger

• Family Medicine Physician in Black Canyon City, AZ
• Providers in Black Canyon City, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; 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.