Active NPI
Robert D Randall Jr., MD
- Surgery Physician
- Rock Hill, SC
National Provider Identifier
1467457424
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 10864
- Practice address
- 1665 Herlong CT
Suite a
Rock Hill, SC 29732-1193 - Phone
- (803) 329-8500
- Fax
- (803) 329-8511
- NPI assigned
- Jun 16, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 10864 | SC | Primary |
| Surgery Physician | 208600000X | 20949 | NC |
Addresses
Primary practice location
1665 Herlong CT
Suite a
Rock Hill, SC 29732-1193
Mailing address
1665 Herlong CT
Suite a
Rock Hill, SC 29732-1193
Phone (803) 329-8500
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 108644 | Medicaid | SC | |
| 297388 | Other | MAMSI | |
| 2073882 | Other | FIRST HEALTH |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20949 | NC | MD | Pharmacist |
| 10864 | SC | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rock Hill Surgical Associates PA | Surgery | 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.
-
- Surgery Physician
- Rock Hill, SC
- NPI 1639173388
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1256774400000",
"number": "1467457424",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1665 HERLONG CT",
"address_2": "SUITE A",
"city": "ROCK HILL",
"state": "SC",
"postal_code": "297321193",
"telephone_number": "803-329-8500",
"fax_number": "803-329-8511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1665 HERLONG CT",
"address_2": "SUITE A",
"city": "ROCK HILL",
"state": "SC",
"postal_code": "297321193",
"telephone_number": "803-329-8500",
"fax_number": "803-329-8511"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDALL",
"first_name": "ROBERT",
"middle_name": "D",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-06-16",
"last_updated": "2009-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "SC",
"license": "10864",
"primary": true
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "NC",
"license": "20949",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "108644",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAMSI",
"identifier": "297388",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST HEALTH",
"identifier": "2073882",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Rock Hill, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.