Brent Randall

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT-556 Issued in ID

Practice address

302 Garnet Dr
Kimberly, ID 83341-1931

Phone

(208) 731-9799

NPI assigned

May 29, 2008

Last updated

May 29, 2008By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Valley Therapy Services IncGroup PAC ID 2567528557, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Valley Therapy Services, Inc.

  • Speech-Language Pathologist
  • Jerome, ID
  • NPI 1639343270
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1212019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212019200000",
    "number": "1497913123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "414 N LINCOLN AVE STE 5",
            "city": "JEROME",
            "state": "ID",
            "postal_code": "833382300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 GARNET DR",
            "city": "KIMBERLY",
            "state": "ID",
            "postal_code": "833411931",
            "telephone_number": "208-731-9799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDALL",
        "first_name": "BRENT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-05-29",
        "last_updated": "2008-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "ID",
            "license": "OT-556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Oak Creek Rehabilitation Center of Kimberly LLC
• Amanda Lachelle Pereira
• Place of Food
• Sara Raeli Prescott, M.S., CF-SLP
• Jysika Lynn Irene Ramirez
• Susan Kathryn Rauma, SLP
• Christine Rene Reeds, OT/L
• Sheri Lynn Remming, MS, LCPC, NCC
• Whitney Retter
• Tyler Richardson, LCSW

• Occupational Therapist in Kimberly, ID
• Providers in Kimberly, ID by specialty
• Occupational Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2008; 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.