Randolph Douglas Gibbs, MD

Primary specialty

Independent Medical Examiner PhysicianTaxonomy code 202C00000X

License

35046271 Issued in OH

Practice address

91275 66TH Ave
Suite 500
Mecca, CA 92254

Phone

(614) 659-0871

NPI assigned

Jun 20, 2007

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles (4 of 5)

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: randolph.gibbs.p5@direct.mydohc.nextgenshare.com

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.

• Clinicas de Salud del Pueblo, Inc

  • Federally Qualified Health Center (FQHC)
  • El Centro, CA
  • NPI 1346313889

  CA

  Medicare reassignment NPD
• Desert Medical Group, Inc.

  • Family Medicine Physician
  • Palm Springs, CA
  • NPI 1114918612

  CA

  Medicare reassignment NPD
• Clinicas de Salud del Pueblo Inc.

  • Community/Retail Pharmacy
  • El Centro, CA
  • NPI 1962045872
  NPD
• Clinicas de Salud del Pueblo, Inc

  • Federally Qualified Health Center (FQHC)
  • Indio, CA
  • NPI 1093138430
  NPD

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

{
    "created_epoch": "1182297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326412800000",
    "number": "1487859294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "91275 66TH AVE",
            "address_2": "SUITE 500",
            "city": "MECCA",
            "state": "CA",
            "postal_code": "92254",
            "telephone_number": "760-396-1249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "91275 66TH AVE",
            "address_2": "SUITE 500",
            "city": "MECCA",
            "state": "CA",
            "postal_code": "92254",
            "telephone_number": "614-659-0871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBBS",
        "first_name": "RANDOLPH",
        "middle_name": "DOUGLAS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-20",
        "last_updated": "2012-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "202C00000X",
            "taxonomy_group": "",
            "desc": "Independent Medical Examiner",
            "state": "OH",
            "license": "35046271",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0504029",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• County of Riverside
• D and a Lee DDS Inc
• Cathryn De Guzman, PA-C
• Vance Laidlaw Fletcher, M.D.
• Galilee Center, Inc.
• Jiliberto Gutierrez-Garcia Jr.
• Ariana Hernandez Perez
• Javier Hernandez, M.D.
• Hussein Hijazi, MD
• Radd Horchin, DDS

• All providers in Mecca, CA
• Independent Medical Examiner Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2012; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.