John Randolph, M.D.
Individual provider Active NPI Family Medicine Physician · Liberty, SC
NPI 1689677882 · NPPES record last updated Oct 14, 2014
Key facts
- NPI
- 1689677882
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 24613 (SC)
- Practice address
- 105 Liberty Blvd
Liberty, SC 29657-1641 - Phone
- (864) 843-8500
- Fax
- (864) 843-5634
- NPI assigned
- May 23, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Ohio State University College of Medicine, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Cannon Memorial Hospital
Practice addresses (Care Compare)
105 Liberty Blvd
Liberty, SC 29657-1641
Phone (864) 843-9213
Hospital & facility affiliations
- Cannon Memorial Hospital
- Anmed Health
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20141226000079 | SC | Practitioner - Family Practice | 2062557622 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35074072 | OH | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cannon Memorial Hospital | Family Medicine | Current |
Accepting new patients |
| Cannon Memorial Hospital | Current |
Accepting new patients | |
| Cannon Memorial Hospital | Current |
Accepting new patients | |
| Cannon Memorial Hospital | Family Medicine | Past |
Accepting new patients |
| Anmed Health | Past | Accepting new patients |
Locations
105 Liberty Blvd
Liberty, SC 29657
Phone (864) 843-8500
123 Wg Acker Dr
Pickens, SC 29671
Phone (864) 512-2465
Interoperability endpoints
- jrandolph45386@direct.anmedhealth.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 35074072 | OH | |
| Family Medicine Physician | 207Q00000X | 24613 | SC | Yes |
Addresses
Primary practice location
105 Liberty Blvd
Liberty, SC 29657-1641
Mailing address
PO Box 919
Pickens, SC 29671-0919
Phone (864) 897-8277
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2141300 | Medicaid | OH |
Other providers in Liberty, SC
- Beverly Yvonne Nelson
- Jack Edward Newsome Jr.
- Palmetto Health
- Papa'S Dream LLC
- Emerson Wiggins Rabon Jr.
- Kelcye Yates Richards
- Rocky Mountain Holdings, LLC
- Maggie Claire Schneider
- Ashley Ricker Shuford
- South Carolina CVS Pharmacy LLC
All providers in Liberty, SC · Family Medicine Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 14, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.