Individual provider Active NPI

Julianne E Randolph, DO

  • Pediatrics Physician
  • Visalia, CA
National Provider Identifier
1508189952
Registry record updated Mar 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
20A11064 Issued in CA
Practice address
400 W Mineral King Ave
Visalia, CA 93291-6237
Phone
(559) 624-2245
Fax
(559) 635-6270
NPI assigned
Mar 12, 2010
Last updated
Mar 1, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 20A11064 CA Primary

Addresses

Primary practice location

400 W Mineral King Ave
Visalia, CA 93291-6237

Mailing address

9300 Valley Childrens PL # SC05
Madera, CA 93636-8761
Phone (559) 353-5700

Other practice location 1

216 E Pine St
Exeter, CA 93221-1750
Phone (559) 592-2600

Other identifiers 1

IdentifierTypeStateIssuer
1508189952MedicaidCA

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20111031000735 CA Practitioner - Pediatric Medicine 3476726886 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
20A11064CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Children's Medical Group Pediatrics CurrentSince Feb 1, 2017 Accepting new patients
Specialty Medical Group Central California, Inc. Pediatrics PastSince Mar 22, 2020 Accepting new patients
Family Healthcare Network Past Accepting new patients
Hanford Community Hospital Past Accepting new patients
Family Healthcare Network Past Accepting new patients
Kaweah Delta Health Care District Past Accepting new patients
Milestone Pediatrics Medical, P.C. Pediatrics PastSince Feb 1, 2022 Accepting new patients
Kealani Sine MD Inc Pediatrics Past Accepting new patients
Milestone Pediatrics, Inc. Pediatrics PastSince May 9, 2021 Accepting new patients

Locations

9300 Valley Childrens Pl
#5
Madera, CA 93636
Phone (559) 353-5700

1524 McHenry Ave
Ste 550570
Modesto, CA 95350
Phone (209) 572-3880

Interoperability endpoints

  • Direct secure messaging: juliannerandolph@trimed.direct-ci.com

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1268352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646092800000",
    "number": "1508189952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9300 VALLEY CHILDRENS PL # SC05",
            "city": "MADERA",
            "state": "CA",
            "postal_code": "936368761",
            "telephone_number": "559-353-5700",
            "fax_number": "559-353-5708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W MINERAL KING AVE",
            "city": "VISALIA",
            "state": "CA",
            "postal_code": "932916237",
            "telephone_number": "559-624-2245",
            "fax_number": "559-635-6270"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "216 E Pine St",
            "address_purpose": "LOCATION",
            "city": "Exeter",
            "state": "CA",
            "postal_code": "932211750",
            "country_code": "US",
            "telephone_number": "559-592-2600",
            "fax_number": "559-592-2610",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "JULIANNE",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-12",
        "last_updated": "2022-03-01",
        "certification_date": "2022-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "20A11064",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1508189952",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Visalia, CA

Sources for this page

Verify at the official NPI Registry.