Randall G. Shue D.O. Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

20A5142 Issued in CA

Legal business name

RANDALL G. SHUE D.O. INC.

Practice address

4055 E Olympic Blvd
#210
Los Angeles, CA 90023-3345

Phone

(323) 268-3491

NPI assigned

Apr 25, 2008

Last updated

Apr 25, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Randall G. Shue, D.O.NPI 1679576730

Title

Owner

Phone

(323) 268-3491

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Tax ID family

Randall G Shue DO Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Randall G. Shue D.O. Inc.

  • Primary Care Clinic/Center
  • Los Angeles, CA
  • NPI 1013265214
  NPD tax ID

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Randall G. Shue D.O. Inc.

  • Primary Care Clinic/Center
  • Los Angeles, CA
  • NPI 1013265214
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Randall G Shue, D.O.

  • Family Medicine Physician
  • Los Angeles, CA
  • NPI 1679576730
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1209081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209081600000",
    "number": "1770758187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4055 E OLYMPIC BLVD",
            "address_2": "#210",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900233345",
            "telephone_number": "323-268-3491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4055 E OLYMPIC BLVD",
            "address_2": "#210",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900233345",
            "telephone_number": "323-268-3491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANDALL G. SHUE D.O. INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-25",
        "last_updated": "2008-04-25",
        "status": "A",
        "authorized_official_last_name": "SHUE",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "323-268-3491",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A5142",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00AX5142",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katherine Rand, MD
• Keith J Rand, MFT
• Rhonda Ellen Rand, MD
• Randal Paul Arase MD a Professional Corporation
• Randall G. Shue D.O. Inc.
• James Randall
• Jocelyn Randall, DPT
• Melissa Randall, M.S., L.C.G.C.
• Sonia Grewal Randall, AUD
• Taylor Jaclyn Randall

• Family Medicine Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2008; 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.