Randal L. Hillis, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

14340 Issued in MO

Practice address

1600 West Harper Street
Poplar Bluff, MO 63901-4119

Phone

(573) 785-6699

Fax

(573) 785-3424

NPI assigned

May 25, 2006

Last updated

Jul 8, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 2, 2019 through Jul 2, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Randal L. Hillis DDS

  • General Practice Dentistry
  • Poplar Bluff, MO
  • NPI 1982765426
  NPD (past) Authorized official
• Dermatology Office PC

  dba Elite Dermatology

  • Dermatology Physician
  • Poplar Bluff, MO
  • NPI 1043462591
  NPD (past)

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562544000000",
    "number": "1710933353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 WEST HARPER STREET",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639014119",
            "telephone_number": "573-785-6699",
            "fax_number": "573-785-3424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 WEST HARPER STREET",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639014119",
            "telephone_number": "573-785-6699",
            "fax_number": "573-785-3424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HILLIS",
        "first_name": "RANDAL",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-25",
        "last_updated": "2019-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "14340",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kalie Hill
• Mary Ruth Hill
• Michael Shawn Hill
• Carrie Hillis
• Melissa Ann Hillis, BA
• Lori Ann Hills
• Michael T Himmelman, PT
• John Paul Hinklin, LPC
• Melisha N Hinklin
• Jessica Raye Hoagland, LCSW

• Dentist in Poplar Bluff, MO
• Providers in Poplar Bluff, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2019; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.