Active NPI
Randall Wayne Henthorn, MD
- Interventional Pain Medicine Physician
- Oklahoma City, OK
National Provider Identifier
1508858804
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Interventional Pain Medicine Physician
- License
- 11470
- Practice address
- 750 NE 13TH St
Oac 200
Oklahoma City, OK 73104-5010 - Phone
- (405) 271-4351
- Fax
- (405) 271-8695
- NPI assigned
- Aug 22, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Interventional Pain Medicine Physician | 208VP0014X | 11470 | OK | Primary |
| Anesthesiology Physician | 207L00000X | 11470 | OK |
Addresses
Primary practice location
750 NE 13TH St
Oac 200
Oklahoma City, OK 73104-5010
Mailing address
1122 NE 13TH St
Ori 236
Oklahoma City, OK 73117-1039
Phone (405) 271-1515
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 352500500 | Other | US DEPT OF LAOR/OWCP | |
| 050080210 | Other | OK | RAILROAD MEDICARE |
| 731590295004 | Other | OK | HUMANA MILITARY |
| 731069171007 | Other | OK | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11470 | OK | MD | Interventional Pain Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344816000000",
"number": "1508858804",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1122 NE 13TH ST",
"address_2": "ORI 236",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731171039",
"telephone_number": "405-271-1515"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "750 NE 13TH ST",
"address_2": "OAC 200",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731045010",
"telephone_number": "405-271-4351",
"fax_number": "405-271-8695"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENTHORN",
"first_name": "RANDALL",
"middle_name": "WAYNE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-22",
"last_updated": "2012-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "208VP0014X",
"taxonomy_group": "",
"desc": "Pain Medicine, Interventional Pain Medicine",
"state": "OK",
"license": "11470",
"primary": true
},
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "OK",
"license": "11470",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "US DEPT OF LAOR/OWCP",
"identifier": "352500500",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "050080210",
"state": "OK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HUMANA MILITARY",
"identifier": "731590295004",
"state": "OK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "731069171007",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.