NPIMap

Organization Active NPI

Patrick D Randolph PHD Inc

  • Psychologist
  • Lubbock, TX
National Provider Identifier
1740267285
Registry record updated Jan 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
24796 Issued in TX
Legal business name
PATRICK D RANDOLPH PHD INC
Practice address
5147 69TH St Ste D
Lubbock, TX 79424-1646
Phone
(806) 771-8808
Fax
(806) 771-8809
NPI assigned
Dec 27, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2024

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

Authorized official

Name
Stephanie Stimac
Title
Office Manager
Phone
(806) 771-8808

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X 24796 TX Primary

Addresses

Primary practice location

5147 69TH St Ste D
Lubbock, TX 79424-1646

Mailing address

5147 69TH St Ste D
Lubbock, TX 79424-1646
Phone (806) 771-8808

Other practice location 1

108 Rose Wood TRL
Alto, NM 88312-8831
Phone (806) 771-8808

Other identifiers 3

IdentifierTypeStateIssuer
0095MQOtherTXBLUE CROSS BLUE SHIELD
0992653MedicaidTX
95074732MedicaidNM

Other names 1

  • Lighthouse Behavioral Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090324000102 TX Part B Supplier - Clinic/Group Practice 7810054632 Receives reassigned benefits from 2 practitioners
Practice locations: Lubbock, TX

National Provider Directory

National Provider Directory

Locations

5147 69th St
Lubbock, TX 79424

5147 69th St
Ste D
Lubbock, TX 79424
Phone (806) 687-3866

6502 Slide Rd
Ste 207
Lubbock, TX 79424
Phone (806) 687-3866

4000 24th St
Lubbock, TX 79410
Phone (806) 725-0000

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1135641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704326400000",
    "number": "1740267285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5147 69TH ST STE D",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794241646",
            "telephone_number": "806-771-8808",
            "fax_number": "806-771-8809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5147 69TH ST STE D",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794241646",
            "telephone_number": "806-771-8808",
            "fax_number": "806-771-8809"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "108 ROSE WOOD TRL",
            "address_purpose": "LOCATION",
            "city": "ALTO",
            "state": "NM",
            "postal_code": "883128831",
            "country_code": "US",
            "telephone_number": "806-771-8808",
            "fax_number": "806-771-8809",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PATRICK D RANDOLPH PHD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-27",
        "last_updated": "2024-01-04",
        "certification_date": "2024-01-02",
        "status": "A",
        "authorized_official_last_name": "STIMAC",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "806-771-8808"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "TX",
            "license": "24796",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0095MQ",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0992653",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "95074732",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lighthouse Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lighthouse Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lubbock, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.