Laura C Randolph, M.D.

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

36-100030 Issued in IL

Practice address

2502 E Empire St
Suite C
Bloomington, IL 61704-3738

Phone

(309) 664-6222

Fax

(309) 664-5006

NPI assigned

Jul 19, 2006

Last updated

Sep 12, 2013By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in IL

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

Plastic and Reconstructive Surgery

Education

Loyola University of Chicago, Stritch School of Medicine, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Carle Bromenn Medical Center Hospital, Normal, IL, CCN 140127
• St Joseph Medical Center Hospital, Bloomington, IL, CCN 140162

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/HAFABD/Endpoint/HAFABD
• Direct secure messaging: laura.randolph@tcps.eclinicaldirectplus.com

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.

• Laura C. Randolph MD SC

  • Medical Specialty Clinic/Center
  • Bloomington, IL
  • NPI 1255527727
  Medicare reassignment NPD
• Gibson Community Hospital Association

  dba Gibson Area Hospital and Health Services

  • Critical Access Hospital
  • Gibson City, IL
  • NPI 1114935681
  NPD (past)

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

• Carle Bromenn Medical Center

  dba Advocate BroMenn Medical Center

  • General Acute Care Hospital
  • Normal, IL
  • NPI 1962424036
  Care Compare affiliation
• St Joseph Medical Center

  dba OSF Saint Joseph Medical Center

  • General Acute Care Hospital
  • Bloomington, IL
  • NPI 1619916806
  Care Compare affiliation

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378944000000",
    "number": "1710906557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2502 E EMPIRE ST",
            "address_2": "SUITE C",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617043738",
            "telephone_number": "309-664-6222",
            "fax_number": "309-664-5006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2502 E EMPIRE ST",
            "address_2": "SUITE C",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617043738",
            "telephone_number": "309-664-6222",
            "fax_number": "309-664-5006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "LAURA",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-19",
        "last_updated": "2013-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "IL",
            "license": "36-100030",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036100030",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RURAL MEDICARE",
            "identifier": "P00193845",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "097565",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "5732066",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH LINK",
            "identifier": "686867",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lawrence Alan Raines, MD
• Renuka Rajagopal, M.D
• Rally Physical Therapy LLC
• Lakshmi Ramesh, DDS
• Gregory Marshall Randolph, D,D.S.
• Amanda M Ratesic
• Sara Renee Rauen Dardis, DDS, MS
• Nita Raut, APN
• Nichole Christine Rave, PA-C
• Bernadette Ray, MD

• Plastic Surgery Physician in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Plastic Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2013; 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.