NPIMap

Individual provider Active NPI

Randy Robert Heisser, MD

  • Family Medicine Physician
  • East Ridge, TN
National Provider Identifier
1689620999
Registry record updated Apr 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
26726 Issued in TN
Practice address
1508 Tombras Ave
East Ridge, TN 37412-2720
Phone
(423) 867-4969
Fax
(423) 867-4971
NPI assigned
May 26, 2006
Last updated
Apr 24, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 26726 TN Primary

Addresses

Primary practice location

1508 Tombras Ave
East Ridge, TN 37412-2720

Mailing address

1508 Tombras Ave
East Ridge, TN 37412-2720
Phone (423) 867-4969

Other identifiers 4

IdentifierTypeStateIssuer
1515872MedicaidTN
TN0104OtherTNJOHN DEERE HEALTH
4165919OtherTNBCBS- TN
F40535OtherTNHEALTHSPRINGS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, GA2 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
I20050422000305 TN Practitioner - Emergency Medicine 4284672965 Reassigns benefits to 4 organizations
I20191001002559 GA Practitioner - Family Practice 4284672965 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Your Good Health, LLCGroup PAC ID 3173615838, 13 clinicians

Practice addresses (Care Compare)

14 Fort Town Dr
Ft Oglethorpe, GA 30742-4051
Phone (706) 866-4443

1508 Tombras Ave
East Ridge, TN 37412-2720
Phone (423) 867-4969

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
26726TNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Chattanooga Family and Sports Medical Center, PLLC CurrentSince Jan 10, 2011 Accepting new patients
Advanced Hyperbaric LLC Family Medicine CurrentSince Sep 19, 2024 Accepting new patients
Trans Med Ambulance, LLC PastSince Jun 15, 2008 Accepting new patients
Hamilton County Department of Education Past Accepting new patients
Healthforce Corporation Family Medicine Past Accepting new patients
Advanced Practice Alliance Family Medicine PastSince Jan 19, 2025 Accepting new patients
WT Chat Op LLC Past Accepting new patients
Cumberland County Board of Education Past Accepting new patients
Emergency Medical Associates Past Accepting new patients
Soddy-Daisy TN Opco LLC Past Accepting new patients
Soddy Daisy Healthcare, LLC Past Accepting new patients
Standifer Gap Rd Healthcare LLC PastSince Nov 13, 2024 Accepting new patients
McMinn County Board of Education Past Accepting new patients
Hearth Healthcare of Georgia, LLC Family Medicine PastSince Feb 2, 2025 Accepting new patients
Jeff Hall Inc Past Accepting new patients
Southeast Transportation, LLC PastSince Aug 29, 2006 Accepting new patients
Emergency Medical Associates Past Accepting new patients
Mountain Family Medical, PLLC Past Accepting new patients

Locations

6035 Shallowford Rd
Ste 101
Chattanooga, TN 37421
Phone (423) 499-0003

5864 Highway 153
Ste 100
Hixson, TN 37343
Phone (423) 486-0010

Interoperability endpoints

  • Direct secure messaging: randy.heisser@ingoodhealth.directbygreenway.com

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Chattanooga Health and Rehab CenterChattanooga, TN, CCN 445205 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Nov 13, 2024
Nov 13, 2024
Hearth HospiceFort Oglethorpe, GA, CCN 111513 Hospice Contracted Managing Employee Jul 1, 2022

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 20

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.

View all 20

Hospital & facility affiliations 11

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": "1148601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524528000000",
    "number": "1689620999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1508 TOMBRAS AVE",
            "city": "EAST RIDGE",
            "state": "TN",
            "postal_code": "374122720",
            "telephone_number": "423-867-4969",
            "fax_number": "423-867-4971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1508 TOMBRAS AVE",
            "city": "EAST RIDGE",
            "state": "TN",
            "postal_code": "374122720",
            "telephone_number": "423-867-4969",
            "fax_number": "423-867-4971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEISSER",
        "first_name": "RANDY",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-26",
        "last_updated": "2018-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "26726",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1515872",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE HEALTH",
            "identifier": "TN0104",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS- TN",
            "identifier": "4165919",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHSPRINGS",
            "identifier": "F40535",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Ridge, TN

Sources for this page

Verify at the official NPI Registry.