Individual provider Active NPI

Randi L Johnson, PA

  • Physician Assistant
  • Rochester, NY
National Provider Identifier
1700122355
Registry record updated Mar 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
23 016413 Issued in NY
Practice address
1000 South Ave
Rochester, NY 14620-2733
Phone
(585) 341-6880
NPI assigned
Dec 28, 2012
Last updated
Mar 4, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 23 016413 NY Primary

Addresses

Primary practice location

1000 South Ave
Rochester, NY 14620-2733

Mailing address

601 Elmwood Ave
Box 655
Rochester, NY 14642-8655
Phone (585) 341-3015

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130530000364 NY Practitioner - Physician Assistant 1052559291 Reassigns benefits to 8 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
016413NYMDClinical Psychologist
23 016413NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
JDS Medical Services PC CurrentSince Dec 30, 2025 Accepting new patients
Cardiac Surgery of the University of Rochester Current Accepting new patients
Hematology Clinical Group Current Accepting new patients
Acute Care Trauma of the University of Rochester Current Accepting new patients
Medical Director Services PC CurrentSince Oct 31, 2025 Accepting new patients
Highland Hospital of Rochester CurrentSince Mar 1, 2016 Accepting new patients
Nicholas H. Noyes Memorial Hospital CurrentSince Nov 18, 2018 Accepting new patients
Highland Hospital of Rochester CurrentSince Mar 1, 2016 Accepting new patients

Locations

50 Sheffield Ave
Brooklyn, NY 11207
Phone (718) 250-8789

73 Buffalo St
Ste 100
Canandaigua, NY 14424

111 Clara Barton St
Dansville, NY 14437
Phone (585) 335-3100

1311 Virginia St
Far Rockaway, NY 11691
Phone (718) 327-2908

1000 South Ave
Rochester, NY 14620
Phone (585) 341-0366

601 Elmwood Ave
Rochester, NY 14642
Phone (585) 275-9555

601 Elmwood Ave
#655
Rochester, NY 14642
Phone (585) 275-9555

Organizations & group practices 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1356652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362355200000",
    "number": "1700122355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 ELMWOOD AVE",
            "address_2": "BOX 655",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146428655",
            "telephone_number": "585-341-3015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 SOUTH AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146202733",
            "telephone_number": "585-341-6880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "RANDI",
        "middle_name": "L",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-28",
        "last_updated": "2013-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "23 016413",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

Verify at the official NPI Registry.