Jeremy Randolph, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

006908 Issued in KY

Practice address

11330 Maple Brook Dr
Louisville, KY 40241-2080

Phone

(502) 426-2221

Fax

(502) 426-2210

NPI assigned

Aug 15, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Osptky LLCGroup PAC ID 6507132107, 30 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Osptky LLC

  • Physical Therapy Clinic/Center
  • Lexington, KY
  • NPI 1083133185

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Osptky LLC

  • Physical Therapy Clinic/Center
  • Richmond, KY
  • NPI 1356834154
  NPD (past)

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

{
    "created_epoch": "1471219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471219200000",
    "number": "1558815985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11330 MAPLE BROOK DR",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402412080",
            "telephone_number": "502-426-2221",
            "fax_number": "502-426-2210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11330 MAPLE BROOK DR",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402412080",
            "telephone_number": "502-426-2221",
            "fax_number": "502-426-2210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "JEREMY",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-15",
        "last_updated": "2016-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KY",
            "license": "006908",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clinton Randall
• Lavonda Nicole Randle, MSN, APRN, ACNPC-AG
• Daniel Randolph, RPH.
• Dave Randolph
• Heather W. Randolph, PSY.D.
• Michelle D Randolph, MSPT
• Random House Community Living Inc
• Ashley Lynn Raney
• Rama S Ranga, R.PH., PH.D
• Chandhiran Rangaswamy, M.D.

• Physical Therapist in Louisville, KY
• Providers in Louisville, KY by specialty
• Physical Therapist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2016; 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.