NPIMap

Individual provider Active NPI

Chaundra Randle, MSW, SSW

  • Social Worker
  • Farmington Hills, MI
National Provider Identifier
1578163580
Registry record updated Oct 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
4578245 Issued in MI
Practice address
21951 Boulder Dr
Farmington Hills, MI 48335-3702
Phone
(313) 720-1987
NPI assigned
Oct 28, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 28, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 4578245 MI Primary

Addresses

Primary practice location

21951 Boulder Dr
Farmington Hills, MI 48335-3702

Mailing address

21951 Boulder Dr
Farmington Hills, MI 48335-3702
Phone (313) 720-1987

Other names 1

  • Ms. Chaundra Johnson Former name

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
4578245MIMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Teladoc Health Medical Group, P.a. Current Accepting new patients

Interoperability endpoints

  • Direct secure messaging: chaundrarandle@tdh.allscriptsdirect.net

Organizations & group practices 1

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": "1603843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603843200000",
    "number": "1578163580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21951 BOULDER DR",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483353702",
            "telephone_number": "313-720-1987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21951 BOULDER DR",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483353702",
            "telephone_number": "313-720-1987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDLE",
        "first_name": "CHAUNDRA",
        "name_prefix": "Mrs.",
        "credential": "MSW, SSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-28",
        "last_updated": "2020-10-28",
        "certification_date": "2020-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "4578245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHAUNDRA",
            "last_name": "JOHNSON",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Farmington Hills, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.