Gannon B Randolph, M.D.

Primary specialty

Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X

License

E5957 Issued in AR

Practice address

1800 SE Moberly LN
Bentonville, AR 72712-7017

Phone

(479) 521-2752

Fax

(479) 521-4603

NPI assigned

Aug 20, 2006

Last updated

Jul 12, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AR

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

Specialty

Orthopedic Surgery

Education

Oregon Health Sciences University School of Medicine, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ozark Orthopaedics, P.a.Group PAC ID 2860477189, 57 clinicians

University of Arkansas for Medical SciencesGroup PAC ID 4082528955, 1,159 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Elite Home Health Home health agency, Springdale, AR, CCN 047346
• Northwest Medical Center-Springdale Hospital, Springdale, AR, CCN 040022
• Mercy Hospital Northwest Arkansas Hospital, Rogers, AR, CCN 040010
• Mercy Hospital Fort Smith Hospital, Fort Smith, AR, CCN 040062
• Washington Regional Medical Center Hospital, Fayetteville, AR, CCN 040004

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: grandolph64353@directa.mercy.net
• Direct secure messaging: rgannon23208@washingtonregional.direct-ci.com

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.

• University of Arkansas for Medical Sciences

  • Internal Medicine Physician
  • Little Rock, AR
  • NPI 1588654016

  Orthopaedic Surgery

  Medicare reassignment Care Compare group NPD
• Ozark Orthopaedics, P.a.

  dba Ozark Orthopaedic and Sports Medicine

  • Orthopaedic Surgery Physician
  • Fayetteville, AR
  • NPI 1649210584
  Medicare reassignment Care Compare group
• Mercy Health Northwest Arkansas Communities

  • Multi-Specialty Clinic/Center
  • Rogers, AR
  • NPI 1265490916
  Medicare reassignment NPD
• Mercy Health Northwest Arkansas Communities

  • Endocrinology, Diabetes & Metabolism Physician
  • Rogers, AR
  • NPI 1770087371
  NPD
• University of Arkansas for Medical Sciences

  • Family Medicine Physician
  • El Dorado, AR
  • NPI 1023795051
  NPD

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

• LHCG Xlii, LLC

  dba Elite Home Health

  • Home Health Agency
  • Springdale, AR
  • NPI 1043557788
  Care Compare affiliation
• Mercy Hospital Fort Smith

  • General Acute Care Hospital
  • Fort Smith, AR
  • NPI 1568433480
  Care Compare affiliation
• Mercy Hospital Rogers

  dba Mercy Hospital Northwest Arkansas

  • General Acute Care Hospital
  • Rogers, AR
  • NPI 1316902414
  Care Compare affiliation
• Northwest Arkansas Hospitals, LLC

  dba Northwest Medical Center

  • General Acute Care Hospital
  • Springdale, AR
  • NPI 1699726695
  Care Compare affiliation
• Washington Regional Medical Center

  • General Acute Care Hospital
  • Fayetteville, AR
  • NPI 1083609150
  Care Compare affiliation

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626048000000",
    "number": "1528173697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3317 N WIMBERLY DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034056",
            "telephone_number": "479-521-2752",
            "fax_number": "479-521-4603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 SE MOBERLY LN",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727127017",
            "telephone_number": "479-521-2752",
            "fax_number": "479-521-4603"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1101 S Horsebarn Rd",
            "address_purpose": "LOCATION",
            "city": "Rogers",
            "state": "AR",
            "postal_code": "727588237",
            "country_code": "US",
            "telephone_number": "479-271-9607",
            "fax_number": "479-271-2133",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "GANNON",
        "middle_name": "B",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-20",
        "last_updated": "2021-07-12",
        "certification_date": "2021-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "AR",
            "license": "E5957",
            "primary": false
        },
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "AR",
            "license": "E5957",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1176259001",
            "state": "AR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gannon.randolph.1@18403.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "Direct message address",
            "address_1": "1800 SE Moberly Ln",
            "city": "Bentonville",
            "state": "AR",
            "country_code": "US",
            "postal_code": "727127017",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Angela Dawn Ramsey, MSN, APRN, FNP-BC
• Haley Elise Ramsey, PHARMD
• Pamela M. Ramsey, MD
• Tyler Ramsey
• Anna J Rand, MHPP
• Terry Lynn Rankin
• Suman S. Rao, MD
• Anthony Raphael Jr., MHPP
• Rapid Results Diagnostics LLC
• Emily Renee Rasmussen-Stallcup, LPTA

• Orthopaedic Surgery of the Spine Physician in Bentonville, AR
• Providers in Bentonville, AR by specialty
• Orthopaedic Surgery of the Spine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.