Individual provider Active NPI

David B Randall, DPM

  • Podiatrist
  • Provo, UT
National Provider Identifier
1710976535
Registry record updated Oct 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
13928903-0501 Issued in UT
Practice address
3355 N University Ave Ste 175
Provo, UT 84604-6620
Phone
(801) 253-6886
NPI assigned
Oct 14, 2005
Last updated
Oct 8, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 246 OK
Podiatrist 213E00000X 7269 AK
Podiatrist 213E00000X 13928903-0501 UT Primary

Addresses

Primary practice location

3355 N University Ave Ste 175
Provo, UT 84604-6620

Mailing address

9980 S 300 W Ste 300
Sandy, UT 84070-3654

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK, UT2 enrollments
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.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120312000214 AK Practitioner - Podiatry 9739087628 Reassigns benefits to 1 organization
I20241021002399 UT Practitioner - Podiatry 9739087628 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

12523 S Creek Meadow Rd
Suite 105
Riverton, UT 84065-7299
Phone (801) 253-6886

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
0 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
0

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue46
Removal of nail tissue177
Removal or shaving of skin growth89

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
246OKMDAddiction (Substance Use Disorder) Counselor
7269AKMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Matt a. Heilala, DPM Inc. CurrentSince Feb 6, 2012 Accepting new patients
Matt a. Heilala, DPM Inc. Podiatrist CurrentSince Feb 6, 2012 Accepting new patients
Ellsworth Foot and Ankle Clinic Podiatrist CurrentSince Sep 14, 2024 Accepting new patients
Ellsworth Foot and Ankle Clinic CurrentSince Sep 14, 2024 Accepting new patients

Locations

4100 Lake Otis Pkwy
Ste 312
Anchorage, AK 99508
Phone (907) 569-3668

3190 E Meridian Park Loop
Ste 205
Wasilla, AK 99654
Phone (907) 373-3338

95 White Sage Ave
Delta, UT 84624
Phone (435) 864-2551

95 White Sage Ave
Ste C
Delta, UT 84624
Phone (435) 864-2251

227 N Westwood Blvd
Price, UT 84501
Phone (801) 794-1490

3355 N University Ave
Ste 175
Provo, UT 84604
Phone (801) 377-5649

12523 S Creek Meadow Rd
Ste 105
Riverton, UT 84065
Phone (801) 337-5855

9980 S 300 W
Ste 300
Sandy, UT 84070
Phone (801) 432-0376

2019 E Riverside Dr
Ste A101
St George, UT 84790
Phone (435) 656-1699

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/21331/brand/1/csg/1/fhir/r4

Organizations & group practices 4

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 1

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": "1129248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728345600000",
    "number": "1710976535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9980 S 300 W STE 300",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840703654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3355 N UNIVERSITY AVE STE 175",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846046620",
            "telephone_number": "801-253-6886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDALL",
        "first_name": "DAVID",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-14",
        "last_updated": "2024-10-08",
        "certification_date": "2024-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "OK",
            "license": "246",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "AK",
            "license": "7269",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "UT",
            "license": "13928903-0501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Provo, UT

Sources for this page

Verify at the official NPI Registry.