Randall Paul Weaver, MSW LCSW 3920

Primary specialty

Social WorkerTaxonomy code 104100000X

License

LCSW3920 Issued in TN

Practice address

101 Lena Drive
Hawkins CN Mental Health Ctr
Rogersville, TN 37857

Phone

(423) 272-9239

Fax

(423) 272-1803

NPI assigned

Aug 13, 2006

Last updated

Jul 8, 2007By 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 1

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Frontier HealthGroup PAC ID 2860302320, 70 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Frontier Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Gray, TN
  • NPI 1720147408
  Medicare reassignment Care Compare group NPD
• Frontier Health

  dba Hancock County Mental Health Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Sneedville, TN
  • NPI 1053475558
  NPD
• Frontier Health

  dba Tennessee Community Support Services

  • Adult Mental Health Clinic/Center
  • Bristol, TN
  • NPI 1821154352
  NPD (past)

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

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689687733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9054",
            "city": "GRAY",
            "state": "TN",
            "postal_code": "376159054",
            "telephone_number": "423-467-3600",
            "fax_number": "423-467-3696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 LENA DRIVE",
            "address_2": "HAWKINS CN MENTAL HEALTH CTR",
            "city": "ROGERSVILLE",
            "state": "TN",
            "postal_code": "37857",
            "telephone_number": "423-272-9239",
            "fax_number": "423-272-1803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEAVER",
        "first_name": "RANDALL",
        "middle_name": "PAUL",
        "name_prefix": "Mr.",
        "credential": "MSW LCSW 3920",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "TN",
            "license": "LCSW3920",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PREF TRIGON HAWKIN",
            "identifier": "178871",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROF TRIGON HAWKIN",
            "identifier": "178871",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROF TRIGON",
            "identifier": "100884",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN SUMMIT",
            "identifier": "4076033",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PREF TRIGON",
            "identifier": "100884",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN NAVIGATOR",
            "identifier": "4076033",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN PINNACLE",
            "identifier": "4076033",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nancy Kaye Waite-O'Brien, PHD
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-3234)
• Wal-Mart Stores East, LP (Vision Center 30-3234)
• Walgreen Co (Walgreens #10960)
• Leigh Andrea Walters, BA
• Carla Jane Weems, APN
• Wellmont Hawkins County Memorial Hospital Inc (Hawkins County Memorial Hospital)
• Wellmont Hawkins County Memorial Hospital Inc. (Wellmont Hawkins County Memorial Hospital Psych)
• Wellmont Hawkins County Memorial Hospital Inc. (Hawkins County Memorial Hospital Swing Bed)
• Wellmont Medical Associates, Inc. (Ballad Health Medical Associates)

• Social Worker in Rogersville, TN
• Providers in Rogersville, TN by specialty
• Social Worker in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.