NPIMap

Individual provider Active NPI

Wayne George Randall

  • Specialist
  • Coquille, OR
National Provider Identifier
1760782726
Registry record updated Oct 25, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
HSP-P-10131631 Issued in OR
Practice address
364 N Central Blvd
Coquille, OR 97423-1244
Phone
(541) 396-4283
Fax
(541) 396-7194
NPI assigned
Oct 25, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 25, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X HSP-P-10131631 OR Primary

Addresses

Primary practice location

364 N Central Blvd
Coquille, OR 97423-1244

Mailing address

364 N Central Blvd
Coquille, OR 97423-1244
Phone (541) 396-4283

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

State licenses

LicenseStateTypeSpecialty
HSP-P-10131631ORMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Oregon Hearing Professionals, Inc. Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1287964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287964800000",
    "number": "1760782726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "364 N CENTRAL BLVD",
            "city": "COQUILLE",
            "state": "OR",
            "postal_code": "974231244",
            "telephone_number": "541-396-4283",
            "fax_number": "541-396-7194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "364 N CENTRAL BLVD",
            "city": "COQUILLE",
            "state": "OR",
            "postal_code": "974231244",
            "telephone_number": "541-396-4283",
            "fax_number": "541-396-7194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDALL",
        "first_name": "WAYNE",
        "middle_name": "GEORGE",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-10-25",
        "last_updated": "2010-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "OR",
            "license": "HSP-P-10131631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coquille, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.