Randall Scott Widmaier, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4220 Issued in AZ

Practice address

5080 N 40TH St Ste 104
Phoenix, AZ 85018-2158

Phone

(602) 954-6200

Fax

(602) 956-1582

NPI assigned

Apr 17, 2006

Sex

Male

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 6

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Specialty

Chiropractic

Education

Palmer College Chiropractic - West Sunnyvale, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/8664/brand/1/csg/1/fhir/r4

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.

• Widmaier Chiropractic

  • Clinic/Center
  • Phoenix, AZ
  • NPI 1205187689
  Medicare reassignment NPD Authorized official
• Precision Surgical LLC

  • Specialist
  • Phoenix, AZ
  • NPI 1285053702
  NPD (past)

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

{
    "created_epoch": "1145232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613606400000",
    "number": "1770548554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5080 N 40TH ST STE 104",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850182158",
            "telephone_number": "602-954-6200",
            "fax_number": "602-956-1582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5080 N 40TH ST STE 104",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850182158",
            "telephone_number": "602-954-6200",
            "fax_number": "602-956-1582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDMAIER",
        "first_name": "RANDALL",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-17",
        "last_updated": "2021-02-18",
        "certification_date": "2021-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "AZ",
            "license": "4220",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "1Z3082",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "AZ0245320",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APIPA",
            "identifier": "818677",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "426305 55",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4268552",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "0628191",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Skylar Ann Wickman
• Laura Wicks, PHARMD
• Victoria Wicus, MOT OTR/L, BCP, CIMI
• Marissa Ann Widener, LPC
• Widmaier Chiropractic
• Courtney Widmer
• Michael Blaine Widmer, DO
• Dayna Alison Widoff, M.S.
• Christopher Sung Wie, MD
• Jordan Wiebe, DO

• Chiropractor in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Chiropractor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.