Randy M Brodnik, DO FACOG
Individual provider Active NPI Obstetrics & Gynecology Physician · Princeton, WV
NPI 1609861996 · NPPES record last updated Feb 4, 2021
Key facts
- NPI
- 1609861996
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 1566 (WV)
- Practice address
- 150 Courthouse Rd Ste 202
Princeton, WV 24740-2450 - Phone
- (304) 327-0531
- Fax
- (304) 324-0548
- NPI assigned
- Sep 13, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 9
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Obstetrics/Gynecology
- Education
- Midwestern University, Chicago College of Osteopathic Med, 1988
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Bluestone Health Association, Inc.
Practice addresses (Care Compare)
3997 Beckley Rd
Princeton, WV 24740-7660
Hospital & facility affiliations
- Centerwell Home Health
- Princeton Community Hospital Assn Inc
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WV, VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120229000540 | WV | Practitioner - Obstetrics/Gynecology | 8628142684 | Reassigns benefits to 2 organizations |
| I20221108003161 | VA | Practitioner - Obstetrics/Gynecology | 8628142684 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bluestone Health Association, Inc. | Current | Accepting new patients | |
| Bluestone Health Association, Inc. | Current | Accepting new patients | |
| Fauquier Physician Practices LLC | Obstetrics & Gynecology | Current |
Accepting new patients |
| Bluestone Health Association, Inc. | Current |
Accepting new patients | |
| Bluestone Health Association, Inc. | Current |
Accepting new patients | |
| Bluestone Health Association, Inc. | Current | Accepting new patients | |
| Bluestone Health Association, Inc. | Current | Accepting new patients | |
| Lima Memorial Joint Operating Company | Past | Accepting new patients |
Locations
330 Seven Springs Way
Brentwood, TN 37027
Phone (615) 920-7780
550 Hospital Dr
Warrenton, VA 20186
Phone (540) 316-5940
500 Hospital Dr
Warrenton, VA 20186
Phone (540) 316-5000
3997 Beckley Rd
Princeton, WV 24740
Phone (304) 431-5499
106 Thorn St
Princeton, WV 24740
Phone (304) 314-7501
Interoperability endpoints
- https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.71392
- rbrodnik@yourcarecommunity.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 1566 | WV | Yes |
Addresses
Primary practice location
150 Courthouse Rd Ste 202
Princeton, WV 24740-2450
Mailing address
150 Courthouse Rd Ste 202
Princeton, WV 24740-2450
Phone (304) 327-0531
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6210970 | Other | VA | VIRGINIA MEDICAID |
| 0093390000 | Medicaid | WV |
Other providers in Princeton, WV
- Halee Brewster
- William Allen Brezinski
- Ashley Marie Bright
- Stacy Briley
- Bobbie Brodell
- Elizabeth Ann Brooks
- Leigh Brooks
- Veronica Sue Brooks
- Zaivyahn Brooks
- Tara Brookshier
All providers in Princeton, WV · Obstetrics & Gynecology Physician in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 4, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.