Individual provider Active NPI

Stephen Hall Randall, M.D.

  • Therapeutic Radiology Physician
  • Syracuse, NY
National Provider Identifier
1669400297
Registry record updated Jan 29, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Therapeutic Radiology PhysicianTaxonomy code 2085R0203X
License
169344-1 Issued in NY
Practice address
1226 E Water St
Syracuse, NY 13210-1155
Phone
(315) 478-3468
Fax
(315) 214-2840
NPI assigned
Jun 30, 2006
Last updated
Jan 29, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Therapeutic Radiology Physician 2085R0203X 169344-1 NY Primary

Addresses

Primary practice location

1226 E Water St
Syracuse, NY 13210-1155

Mailing address

1226 E Water St
Syracuse, NY 13210-1155
Phone (315) 478-4185

Other identifiers 1

IdentifierTypeStateIssuer
01262477MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051031000358 NY Practitioner - Radiation Oncology 1254358153 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
University of Mississippi School of Medicine, 1973
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Associated Medical Professionals of Ny PLLCGroup PAC ID 0749378123, 57 clinicians

Practice addresses (Care Compare)

1226 E Water St
Syracuse, NY 13210-1155
Phone (315) 478-4185

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
169344-1NYMDTherapeutic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Associated Medical Professionals of Ny, PLLC CurrentSince Feb 28, 2011 Accepting new patients
Associated Medical Professionals of Ny, PLLC CurrentSince Feb 28, 2011 Accepting new patients
North Medical Radiotherapy, P.C. Past Accepting new patients
Upstate University Radiation Oncology, Inc. Past Accepting new patients

Locations

100 Metropolitan Park Dr
Ste 100
Liverpool, NY 13088
Phone (315) 870-9370

2 Ellinwood Dr
New Hartford, NY 13413
Phone (315) 507-5081

1226 E Water St
Syracuse, NY 13210
Phone (315) 423-7226

Organizations & group practices 4

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 1

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": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359417600000",
    "number": "1669400297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1226 E WATER ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132101155",
            "telephone_number": "315-478-4185",
            "fax_number": "315-478-0840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1226 E WATER ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132101155",
            "telephone_number": "315-478-3468",
            "fax_number": "315-214-2840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDALL",
        "first_name": "STEPHEN",
        "middle_name": "HALL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-30",
        "last_updated": "2013-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0203X",
            "taxonomy_group": "",
            "desc": "Radiology, Therapeutic Radiology",
            "state": "NY",
            "license": "169344-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01262477",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.