Randolph Diabetes and Wellness LLC

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

Legal business name

RANDOLPH DIABETES AND WELLNESS LLC

Practice address

13047 W Linebaugh Ave Ste 102
Tampa, FL 33626-4487

Phone

(813) 475-6542

Fax

(813) 475-6874

NPI assigned

Mar 2, 2018

Organization subpart

No

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

Authorized official

Name

Ms. Kimberly T Randolph, APRN-CNPI 1457788671

Title

Owner/Manager

Phone

(813) 846-7698

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/21490/brand/1/csg/1/fhir/r4

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kimberly T Randolph, ARNP-C

  • Adult Health Nurse Practitioner
  • Tampa, FL
  • NPI 1457788671
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1519948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620777600000",
    "number": "1609378991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13047 W LINEBAUGH AVE STE 102",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336264487",
            "telephone_number": "813-475-6542",
            "fax_number": "813-475-6874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13047 W LINEBAUGH AVE STE 102",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336264487",
            "telephone_number": "813-475-6542",
            "fax_number": "813-475-6874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANDOLPH DIABETES AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-02",
        "last_updated": "2021-05-12",
        "certification_date": "2021-05-12",
        "status": "A",
        "authorized_official_last_name": "RANDOLPH",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "813-846-7698",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "APRN-C"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "ARNP9318390",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.randolphwellness.com",
            "affiliation": "N",
            "address_1": "13047 W Linebaugh Ave Ste 102",
            "city": "Tampa",
            "state": "FL",
            "country_code": "US",
            "postal_code": "336264487",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Meghan Michelle Randall, RN
• Rodney Richard Randall, M.D.
• Joseph C Randazzo Jr., PA-C
• Randall F Randazzo, M.D.
• Tara Marie Randis, M.D.
• Kimberly T Randolph, ARNP-C
• Tiffaney Sharee Randolph, ACNP-BC
• Victoria Elizabeth Randolph, PHARMD
• Rishi Rane, M.D.
• Judith Ranells, MD

• Adult Medicine Physician in Tampa, FL
• Providers in Tampa, FL by specialty
• Adult Medicine Physician in Florida

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