Carrie MD Randolph, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1346 Issued in AK

Practice address

506 W Marine Way
Kodiak, AK 99615-7311

Phone

(907) 486-3269

NPI assigned

Aug 2, 2010

Last updated

Sep 30, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

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 1

Medicare enrollment (NPD)

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.

• Carrie Randolph D.D.S. Inc.

  • Dentist
  • Kodiak, AK
  • NPI 1588113187
  NPD (past) Authorized official
• James R. Arneson, DDS,Inc

  • General Practice Dentistry
  • Kodiak, AK
  • NPI 1750728747
  NPD (past)

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

{
    "created_epoch": "1280707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475193600000",
    "number": "1740594779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "506 W MARINE WAY",
            "city": "KODIAK",
            "state": "AK",
            "postal_code": "996157311",
            "telephone_number": "907-486-3269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 W MARINE WAY",
            "city": "KODIAK",
            "state": "AK",
            "postal_code": "996157311",
            "telephone_number": "907-486-3269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "CARRIE",
        "middle_name": "MD",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-02",
        "last_updated": "2016-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AK",
            "license": "1346",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AK OCCUPATIONAL LICENSE",
            "identifier": "1346",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eugene Thomas Pryka, INDEPENDENT DUTY HS
• Aliitasi Pesio Puckett, HEALTH SERVICES TECH
• Penny K Puhak, ETC
• Elizabeth M Pyanowski, RN
• Megan Nicole Pyles
• Sarah Rastopsoff
• Monique Patricia Reckner, RN
• Bonnie Reilly
• Shim-in Sarah Reyes
• Erik Abraham Riutta, PHARMD

• General Practice Dentistry in Kodiak, AK
• Providers in Kodiak, AK by specialty
• General Practice Dentistry in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.