NPIMap

Individual provider Active NPI

Randolph Mitchell Jenkins Jr., M.D.

  • Physical Medicine & Rehabilitation Physician
  • Petersburg, VA
National Provider Identifier
1760878144
Registry record updated May 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
0101261201 Issued in VA
Practice address
95 Medical Park Blvd
Petersburg, VA 23805-9280
Phone
(804) 504-8100
NPI assigned
Apr 12, 2015
Last updated
May 18, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 0101261201 VA Primary

Addresses

Primary practice location

95 Medical Park Blvd
Petersburg, VA 23805-9280

Mailing address

95 Medical Park Blvd
Petersburg, VA 23805-9280
Phone (804) 504-8100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190717000629 VA Practitioner - Physical Medicine and Rehabilitation 8426362237 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
GMGP Health Group LLCGroup PAC ID 9436561800, 13 clinicians

Practice addresses (Care Compare)

95 Medical Park Blvd
Petersburg, VA 23805-9280
Phone (336) 816-2589

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0101261201VAMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
GMGP Health Group LLC Physical Medicine & Rehabilitation CurrentSince Dec 1, 2020 Accepting new patients
Legacy Care Aco LLC CurrentSince Jun 18, 2023 Accepting new patients
Encompass Health Rehabilitation Hospital of Petersburg, LLC Past Accepting new patients

Locations

1401 Johnston Willis Dr
North Chesterfield, VA 23235
Phone (804) 327-4046

95 Medical Park Blvd
Petersburg, VA 23805
Phone (336) 816-2589

4201 Greenwood Dr
Portsmouth, VA 23701
Phone (757) 654-1444

2901 S Lynnhaven Rd
Ste 450
Virginia Beach, VA 23452
Phone (757) 351-4585

780 Lynnhaven Pkwy
Ste 400
Virginia Beach, VA 23452
Phone (201) 581-3411

Organizations & group practices 3

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 10

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": "1428796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652832000000",
    "number": "1760878144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 MEDICAL PARK BLVD",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238059280",
            "telephone_number": "804-504-8100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 MEDICAL PARK BLVD",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238059280",
            "telephone_number": "804-504-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENKINS",
        "first_name": "RANDOLPH",
        "middle_name": "MITCHELL",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-12",
        "last_updated": "2022-05-18",
        "certification_date": "2022-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "VA",
            "license": "0101261201",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Petersburg, VA

Sources for this page

Verify at the official NPI Registry.