Individual provider Active NPI

Lauren Randall, DPT

  • Physical Therapist
  • Wallingford, CT
National Provider Identifier
1508385584
Registry record updated Aug 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
13215 Issued in CT
Practice address
97 Barnes Rd
Wallingford, CT 06492-1885
Phone
(203) 793-7592
NPI assigned
Sep 11, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 13215 CT Primary

Addresses

Primary practice location

97 Barnes Rd
Wallingford, CT 06492-1885

Mailing address

5 Tarragon Dr
East Hampton, CT 06424-1757
Phone (860) 916-7870

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210819002695 CT Practitioner - Physical Therapist in Private Practice 8325443922 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anb-Ptsma Holdings IncGroup PAC ID 4789572926, 190 clinicians

Practice addresses (Care Compare)

103 E Main St
Unit C
Plainville, CT 06062-1968
Phone (860) 517-8885

860 N Main St Ext
Wallingford, CT 06492-2449
Phone (203) 793-7592

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
13215CTMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Anb-Ptsma Holdings, Inc. Physical Therapist CurrentSince Aug 4, 2021 Accepting new patients
Sacred Heart University, Inc Physical Therapist Past Accepting new patients

Locations

103 E Main St
Unit C
Plainville, CT 06062
Phone (860) 517-8885

97 Barnes Rd
Wallingford, CT 06492
Phone (203) 284-3137

860 N Main Street Ext
Wallingford, CT 06492
Phone (203) 793-7592

47 N Main St
West Hartford, CT 06107
Phone (860) 409-4595

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1505088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628035200000",
    "number": "1508385584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 TARRAGON DR",
            "city": "EAST HAMPTON",
            "state": "CT",
            "postal_code": "064241757",
            "telephone_number": "860-916-7870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "97 BARNES RD",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064921885",
            "telephone_number": "203-793-7592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDALL",
        "first_name": "LAUREN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-11",
        "last_updated": "2021-08-04",
        "certification_date": "2021-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CT",
            "license": "13215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wallingford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2021; 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.