John Randolph, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

24613 Issued in SC

Practice address

105 Liberty Blvd
Liberty, SC 29657-1641

Phone

(864) 843-8500

Fax

(864) 843-5634

NPI assigned

May 23, 2005

Last updated

Oct 14, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

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

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 HospitalGroup PAC ID 8123930666, shared by 4 NPIs, 30 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Cannon Memorial Hospital Hospital, Pickens, SC, CCN 420011
• Anmed Health Hospital, Anderson, SC, CCN 420027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jrandolph45386@direct.anmedhealth.net

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.

• Cannon Memorial Hospital

  dba AnMed Cannon

  • General Acute Care Hospital
  • Pickens, SC
  • NPI 1497744254
  Medicare reassignment NPD
• Cannon Memorial Hospital

  dba AnMed Primary Care-Liberty

  • Family Medicine Physician
  • Liberty, SC
  • NPI 1750304135
  Medicare reassignment NPD
• Cannon Memorial Hospital

  dba AnMed Cannon

  • Emergency Medicine Physician
  • Pickens, SC
  • NPI 1245930064
  NPD
• Anmed Health

  dba AnMed

  • Emergency Medicine Physician
  • Anderson, SC
  • NPI 1710918321
  NPD (past)
• Cannon Memorial Hospital

  dba AnMed Health Orthopaedics and Sports Medicine- Cannon

  • Orthopaedic Surgery Physician
  • Pickens, SC
  • NPI 1861645558

  Family Medicine

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Anmed Health

  dba AnMed

  • General Acute Care Hospital
  • Anderson, SC
  • NPI 1417919531
  Care Compare affiliation
• Cannon Memorial Hospital

  dba AnMed Cannon

  • General Acute Care Hospital
  • Pickens, SC
  • NPI 1497744254
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413244800000",
    "number": "1689677882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 919",
            "city": "PICKENS",
            "state": "SC",
            "postal_code": "296710919",
            "telephone_number": "864-897-8277",
            "fax_number": "864-878-0035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 LIBERTY BLVD",
            "city": "LIBERTY",
            "state": "SC",
            "postal_code": "296571641",
            "telephone_number": "864-843-8500",
            "fax_number": "864-843-5634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-23",
        "last_updated": "2014-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35074072",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "24613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beverly Yvonne Nelson
• Jack Edward Newsome Jr., D.C.
• Palmetto Health (Liberty Family Care)
• Papa's Dream LLC
• Emerson Wiggins Rabon Jr., DDS
• Kelcye Yates Richards, PA
• Rocky Mountain Holdings, LLC (LifeNet South Carolina)
• Maggie Claire Schneider
• Ashley Ricker Shuford, PHARM.D.
• South Carolina CVS Pharmacy LLC (CVS Pharmacy #05598)

• Family Medicine Physician in Liberty, SC
• Providers in Liberty, SC by specialty
• Family Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.