NPIMap

Individual provider Active NPI

Randall G. Lorenz, MD

  • Internal Medicine Physician
  • Moscow, ID
National Provider Identifier
1669430955
Registry record updated Nov 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
34153 Issued in AZ
Practice address
623 South Main Street
Moscow, ID 83843
Phone
(208) 882-2011
Fax
(208) 883-1853
NPI assigned
May 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2011

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 34153 AZ Primary
Internal Medicine Physician 207R00000X ME83125 FL
Internal Medicine Physician 207R00000X G31181 CA
Internal Medicine Physician 207R00000X MD11024 OR

Addresses

Primary practice location

623 South Main Street
Moscow, ID 83843

Mailing address

623 South Main Street
Moscow, ID 83843
Phone (208) 882-2011

Other identifiers 1

IdentifierTypeStateIssuer
946345MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
31181CAMDChiropractor
G31181CAMDInternal Medicine Physician
ME83125FLMDInternal Medicine Physician
MD11024ORMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Affiliated Hospitalists, PLC Internal Medicine PastSince Jan 1, 2013 Accepting new patients
Oro Valley Hospital LLC Past Accepting new patients
Mark Twain Medical Center Past Accepting new patients
Northwest Allied Physicians, LLC Past Accepting new patients
Oro Valley Hospital LLC Internal Medicine Past Accepting new patients
Northwest Hospital LLC Past Accepting new patients
Northwest Allied Physicians LLC Internal Medicine PastSince Jun 1, 2006 Accepting new patients

Organizations & group practices 7

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": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321920000000",
    "number": "1669430955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "623 SOUTH MAIN STREET",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "83843",
            "telephone_number": "208-882-2011",
            "fax_number": "208-883-1853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "623 SOUTH MAIN STREET",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "83843",
            "telephone_number": "208-882-2011",
            "fax_number": "208-883-1853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LORENZ",
        "first_name": "RANDALL",
        "middle_name": "G.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-03",
        "last_updated": "2011-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "34153",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME83125",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G31181",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD11024",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "946345",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Moscow, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.