Active NPI
Professional Foot & Ankle LLC
- Podiatrist
- Park Forest, IL
National Provider Identifier
1467606152
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- 016005113
- Legal business name
- PROFESSIONAL FOOT & ANKLE LLC
- Practice address
- 231 Main St
Park Forest, IL 60466-2097 - Phone
- (708) 749-3338
- Fax
- (708) 748-4332
- NPI assigned
- Nov 8, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Jerome R Randall Jr., DPM
- Title
- Member
- Phone
- (708) 250-0785
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 016005113 | IL | Primary |
Addresses
Primary practice location
231 Main St
Park Forest, IL 60466-2097
Mailing address
PO Box 1889
Matteson, IL 60443-4889
Phone (708) 250-0785
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4632153 | Other | IL | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
National Provider Directory
National Provider DirectoryLocations
20303 Crawford Ave
Ste 210
Olympia Flds, IL 60461
Phone (708) 365-8281
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Podiatrist
- Park Forest, IL
- NPI 1376689257
-
- Foot & Ankle Surgery Podiatrist
- Mokena, IL
- NPI 1811078207
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1226102400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1747440000000",
"number": "1467606152",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1889",
"city": "MATTESON",
"state": "IL",
"postal_code": "604434889",
"telephone_number": "708-250-0785",
"fax_number": "708-898-2326"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "231 MAIN ST",
"city": "PARK FOREST",
"state": "IL",
"postal_code": "604662097",
"telephone_number": "708-749-3338",
"fax_number": "708-748-4332"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PROFESSIONAL FOOT & ANKLE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2008-11-08",
"last_updated": "2025-05-17",
"certification_date": "2025-05-17",
"status": "A",
"authorized_official_last_name": "RANDALL",
"authorized_official_first_name": "JEROME",
"authorized_official_middle_name": "R",
"authorized_official_title_or_position": "MEMBER",
"authorized_official_telephone_number": "708-250-0785",
"authorized_official_name_prefix": "Dr.",
"authorized_official_name_suffix": "Jr.",
"authorized_official_credential": "DPM"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Podiatrist",
"state": "IL",
"license": "016005113",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "4632153",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Park Forest, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.