NPIMap

Individual provider Active NPI

Randy M Brodnik, DO FACOG

  • Obstetrics & Gynecology Physician
  • Princeton, WV
National Provider Identifier
1609861996
Registry record updated Feb 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
1566 Issued in 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
Last updated
Feb 4, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 4, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 1566 WV Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV, VA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120229000540 WV Practitioner - Obstetrics/Gynecology 8628142684 Reassigns benefits to 2 organizations
I20221108003161 VA Practitioner - Obstetrics/Gynecology 8628142684 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
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.Group PAC ID 3577505221, shared by 7 NPIs, 38 clinicians

Practice addresses (Care Compare)

3997 Beckley Rd
Princeton, WV 24740-7660

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
1566WVMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Bluestone Health Association, Inc. CurrentSince Oct 29, 2024 Accepting new patients
Bluestone Health Association, Inc. Current Accepting new patients
Bluestone Health Association, Inc. CurrentSince Oct 29, 2024 Accepting new patients
Bluestone Health Association, Inc. Current Accepting new patients
Bluestone Health Association, Inc. Current Accepting new patients
Fauquier Physician Practices LLC Obstetrics & Gynecology CurrentSince Sep 1, 2022 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

500 Hospital Dr
Warrenton, VA 20186
Phone (540) 316-5000

550 Hospital Dr
Warrenton, VA 20186
Phone (540) 316-5940

106 Thorn St
Princeton, WV 24740
Phone (304) 314-7501

3997 Beckley Rd
Princeton, WV 24740
Phone (304) 431-5499

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.71392
  • Direct secure messaging: rbrodnik@yourcarecommunity.org

Organizations & group practices 10

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1126569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612396800000",
    "number": "1609861996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 COURTHOUSE RD STE 202",
            "city": "PRINCETON",
            "state": "WV",
            "postal_code": "247402450",
            "telephone_number": "304-327-0531",
            "fax_number": "304-324-0548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 COURTHOUSE RD STE 202",
            "city": "PRINCETON",
            "state": "WV",
            "postal_code": "247402450",
            "telephone_number": "304-327-0531",
            "fax_number": "304-324-0548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODNIK",
        "first_name": "RANDY",
        "middle_name": "M",
        "credential": "DO FACOG",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-13",
        "last_updated": "2021-02-04",
        "certification_date": "2021-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "WV",
            "license": "1566",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Princeton, WV

Sources for this page

Verify at the official NPI Registry.