Cleveland W Randolph, Jr, MD, PA

Primary specialty

SpecialistTaxonomy code 174400000X

License

ME0042493 Issued in FL

Legal business name

CLEVELAND W RANDOLPH, JR, MD, PA

Practice address

1891 Beach Blvd Ste 200
Jacksonville Beach, FL 32250-2644

Phone

(904) 249-3743

Fax

(904) 249-2047

NPI assigned

Jan 18, 2007

Organization subpart

No

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

Authorized official

Name

Victoria Louise Galler

Title

Practice Administrator

Phone

(904) 249-3743

Specialties & licenses 1

Addresses

Other names 1

• Dr. Randolph's Ageless & Wellness Medical Center Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Cleveland Randolph Jr MD2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Cleveland Randolph, Jr, MD, PA

  • Pharmacy
  • Jacksonville Beach, FL
  • NPI 1629467782
  NPD tax ID

Locations

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Esteban Garces, APRN

  • Family Nurse Practitioner
  • Jacksonville Beach, FL
  • NPI 1295176998
  Medicare reassignment Care Compare group NPD
• Sherri K Jackson, APRN

  • Family Nurse Practitioner
  • Jacksonville Beach, FL
  • NPI 1144657263
  Medicare reassignment Care Compare group NPD
• Donny Klay, APRN

  • Nurse Practitioner
  • Jacksonville Beach, FL
  • NPI 1093183444
  Medicare reassignment Care Compare group NPD
• Lori A Leaseburge, MD

  • Obstetrics Physician
  • Jacksonville, FL
  • NPI 1275628455
  Medicare reassignment Care Compare group NPD
• Anthony Atwood Premo, APRN, AGACNP-BC

  • Adult Health Nurse Practitioner
  • Jacksonville, FL
  • NPI 1033840806
  Medicare reassignment Care Compare group NPD
• Cleveland W Randolph Jr., M.D.

  • Specialist
  • Jacksonville Beach, FL
  • NPI 1124014287
  Medicare reassignment Care Compare group NPD
• Malissa Ann Richter, APRN

  • Family Nurse Practitioner
  • Jacksonville, FL
  • NPI 1609407428
  Medicare reassignment Care Compare group NPD
• Nicole Thomas, APRN

  • Nurse Practitioner
  • Jacksonville Beach, FL
  • NPI 1003065509
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764547200000",
    "number": "1497808182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1891 BEACH BLVD STE 200",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322502644",
            "telephone_number": "904-249-3743",
            "fax_number": "904-249-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1891 BEACH BLVD STE 200",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322502644",
            "telephone_number": "904-249-3743",
            "fax_number": "904-249-2047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEVELAND W RANDOLPH, JR, MD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2025-12-01",
        "certification_date": "2025-12-01",
        "status": "A",
        "authorized_official_last_name": "GALLER",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_middle_name": "LOUISE",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "904-249-3743"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME0042493",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Randolph's Ageless & Wellness Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Katrina Cinca, ARNP
• Cipriano&Johnson Counseling LLC
• Cisca Pulmonary Critical Care Inc
• Lucy Ann Clark, LUCY CLARK
• Cleveland Randolph, Jr, MD, PA
• Coastal Therapy & Learning Center, Inc.
• Cogent Healthcare of Pensacola LLC
• Ryan Colaianni, DMD
• Abigail L Colarusso, OTD, OTR/L
• Sara L Colby, MD

• Specialist in Jacksonville Beach, FL
• Providers in Jacksonville Beach, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.