Individual provider Active NPI

Michelle Randall, PA-C

  • Physician Assistant
  • Cincinnati, OH
National Provider Identifier
1629552302
Registry record updated Jun 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.008315RX Issued in OH
Practice address
2170 Anderson Ferry Rd
Cincinnati, OH 45238-3328
Phone
(513) 922-4271
NPI assigned
Sep 19, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 50.008315RX OH Primary

Addresses

Primary practice location

2170 Anderson Ferry Rd
Cincinnati, OH 45238-3328

Mailing address

2170 Anderson Ferry Rd
Cincinnati, OH 45238-3328

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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

Enrollment IDStateProvider typePAC IDDetails
I20190228001425 MO Practitioner - Physician Assistant 8729327267 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
50.008315RXOHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Swope Health Services CurrentSince Jan 5, 2019 Accepting new patients
Christian Community Health Services Past Accepting new patients
Christian Community Health Services Past Accepting new patients
Christian Community Health Services Past Accepting new patients

Locations

3801 Dr Martin Luther King Jr Blvd
Kansas City, MO 64130
Phone (816) 599-5500

Organizations & group practices 5

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": "1537315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717459200000",
    "number": "1629552302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2170 ANDERSON FERRY RD",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452383328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2170 ANDERSON FERRY RD",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452383328",
            "telephone_number": "513-922-4271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDALL",
        "first_name": "MICHELLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-19",
        "last_updated": "2024-06-04",
        "certification_date": "2024-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.008315RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

Verify at the official NPI Registry.