Active NPI
Randy Lyman Bishop, M.S.
- Audiologist
- Pocatello, ID
National Provider Identifier
1720004419
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- AUD 1225
- Practice address
- 650 Medical Dr
#68
Pocatello, ID 83209-0001 - Phone
- (208) 282-4034
- Fax
- (208) 282-4571
- NPI assigned
- Jul 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | AUD 1225 | ID | Primary |
Addresses
Primary practice location
650 Medical Dr
#68
Pocatello, ID 83209-0001
Mailing address
650 Medical Dr
#68
Pocatello, ID 83209-0001
Phone (208) 282-4034
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AU 761 | Other | ID | BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AUD 1225 | ID | MD | Audiologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720004419",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "650 MEDICAL DR",
"address_2": "#68",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832090001",
"telephone_number": "208-282-4034",
"fax_number": "208-282-4571"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 MEDICAL DR",
"address_2": "#68",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832090001",
"telephone_number": "208-282-4034",
"fax_number": "208-282-4571"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BISHOP",
"first_name": "RANDY",
"middle_name": "LYMAN",
"name_prefix": "Mr.",
"credential": "M.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "ID",
"license": "AUD 1225",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "AU 761",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pocatello, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.