NPIMap

Individual provider Active NPI

Randall Whitaker Maxey, MD PHD

  • Nephrology Physician
  • Inglewood, CA
National Provider Identifier
1700944279
Registry record updated Sep 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
C38014 Issued in CA
Practice address
447 N Prairie Ave
Inglewood, CA 90301-1413
Phone
(310) 680-1810
Fax
(310) 680-1811
NPI assigned
Dec 5, 2006
Last updated
Sep 26, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 26, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X C38014 CA Primary

Addresses

Primary practice location

447 N Prairie Ave
Inglewood, CA 90301-1413

Mailing address

PO Box 83246
Los Angeles, CA 90083-0246
Phone (310) 680-1810

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081215000265 CA Practitioner - Nephrology 3375647498 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Howard University College of Medicine, 1972
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Healing Hands Medical Group, a Medical CorporationGroup PAC ID 5991894537, 2 clinicians

Practice addresses (Care Compare)

2975 Wilshire Blvd
Suite 450
Los Angeles, CA 90010-1125
Phone (213) 368-1654

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
38014CAMDGeneral Practice Dentistry
C38014CAMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
All Home Mobile Services Inc. CurrentSince Apr 4, 2023 Accepting new patients
Healing Hands Medical Group, a Medical Corporation Nephrology CurrentSince Sep 1, 2013 Accepting new patients
Randall Maxey, MD, Corp Current Accepting new patients
Atlantis Health Care Group Puerto Rico, Inc. PastSince Sep 15, 2013 Accepting new patients
Los Angeles Multispecialty Medical Group Nephrology Past Accepting new patients
Advanced Community Medical Care Corporation Nephrology Past Accepting new patients

Locations

2975 Wilshire Blvd
Ste 401
Los Angeles, CA 90010
Phone (213) 368-1654

2975 Wilshire Blvd
Ste 450
Los Angeles, CA 90010
Phone (213) 368-1654

4795 Holt Blvd
Ste 205
Montclair, CA 91763
Phone (714) 496-5710

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: randall.maxey@3443.securemail.prognocis.com
  • Direct secure messaging: randall.maxey@3613.securemail.prognocis.com

Organizations & group practices 9

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.

Hospital & facility affiliations 6

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": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569456000000",
    "number": "1700944279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 83246",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900830246",
            "telephone_number": "310-680-1810",
            "fax_number": "310-680-1811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "447 N PRAIRIE AVE",
            "city": "INGLEWOOD",
            "state": "CA",
            "postal_code": "903011413",
            "telephone_number": "310-680-1810",
            "fax_number": "310-680-1811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAXEY",
        "first_name": "RANDALL",
        "middle_name": "WHITAKER",
        "name_prefix": "Dr.",
        "credential": "MD PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-05",
        "last_updated": "2019-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "C38014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Inglewood, CA

Sources for this page

Verify at the official NPI Registry.