Amy Jo Randolph, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110005390 Issued in VA

Practice address

66 Parkway LN
Suite 101a
Fishersville, VA 22939-2384

Phone

(540) 451-2833

NPI assigned

Jun 23, 2016

Sex

Female

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 VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Shenandoah Dermatology, P.C.

  • Specialist
  • Staunton, VA
  • NPI 1023484219
  Medicare reassignment
• Blue Ridge Foot and Ankle Clinic PLC

  • Foot & Ankle Surgery Podiatrist
  • Charlottesville, VA
  • NPI 1730112475
  NPD (past)

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

{
    "created_epoch": "1466640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466726400000",
    "number": "1619328465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 PARKWAY LN",
            "address_2": "SUITE 101A",
            "city": "FISHERSVILLE",
            "state": "VA",
            "postal_code": "229392384",
            "telephone_number": "540-451-2833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 PARKWAY LN",
            "address_2": "SUITE 101A",
            "city": "FISHERSVILLE",
            "state": "VA",
            "postal_code": "229392384",
            "telephone_number": "540-451-2833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "AMY",
        "middle_name": "JO",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-23",
        "last_updated": "2016-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110005390",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carol Quesenberry, OTR/L
• Catherine Ebbets Quick, CNM
• Clayton Rainie, DPT, PT
• Samantha Rainie, PT, DPT
• Rahimeen Rajpar, MD
• Joseph Lange Ranzini, M.D.
• Adam Rasoul, MD
• Lori Ratliff, R.N., N.P.
• Kelvin B Raybon, M.D.
• Suzanna Hicks Rea, FNP

• Physician Assistant in Fishersville, VA
• Providers in Fishersville, VA by specialty
• Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.