NPIMap

Individual provider Active NPI

Christina Nicole Randall, PA-C

  • Medical Physician Assistant
  • Greenville, SC
National Provider Identifier
1518112689
Registry record updated Jun 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
1365 Issued in SC
Practice address
111 Doctors Dr
Greenville, SC 29605-5622
Phone
(864) 797-7100
Fax
(864) 797-7105
NPI assigned
Nov 17, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 1365 SC Primary

Addresses

Primary practice location

111 Doctors Dr
Greenville, SC 29605-5622

Mailing address

1 Independence PT
Suite 212
Greenville, SC 29615-4545
Phone (864) 797-6044

Other practice location 1

35 International Dr
Greenville, SC 29615-4816
Phone (864) 351-0764

Other identifiers 1

IdentifierTypeStateIssuer
1150PAMedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110310000365 SC Practitioner - Physician Assistant 1951583012 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Medical University of South Carolina College of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

131 Commonwealth Dr
Suite 240
Greenville, SC 29615-5194
Phone (864) 297-0080

317 Saint Francis Dr
Suite 220
Greenville, SC 29601-3976
Phone (864) 255-1901

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1365SCMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Bon Secours Medical Group Greenville Specialty Care LLC CurrentSince May 20, 2024 Accepting new patients
Bon Secours Medical Group Greenville Specialty Care LLC CurrentSince May 20, 2024 Accepting new patients
The Children's Clinic Past Accepting new patients
Lung Center LLC Past Accepting new patients

Locations

35 International Dr
Greenville, SC 29615
Phone (864) 242-5020

317 Saint Francis Dr
Ste 220
Greenville, SC 29601
Phone (864) 255-1901

131 Commonwealth Dr
Ste 390
Greenville, SC 29615
Phone (864) 335-7555

Interoperability endpoints

  • Direct secure messaging: crandall2593897@direct.bsmhealth.org

Organizations & group practices 4

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1226880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717632000000",
    "number": "1518112689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 INDEPENDENCE PT",
            "address_2": "SUITE 212",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154545",
            "telephone_number": "864-797-6044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 DOCTORS DR",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296055622",
            "telephone_number": "864-797-7100",
            "fax_number": "864-797-7105"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "35 International Dr",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "SC",
            "postal_code": "296154816",
            "country_code": "US",
            "telephone_number": "864-351-0764",
            "fax_number": "833-459-0882",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RANDALL",
        "first_name": "CHRISTINA",
        "middle_name": "NICOLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-17",
        "last_updated": "2024-06-06",
        "certification_date": "2024-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "SC",
            "license": "1365",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1150PA",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.