Active NPI
Randolph James Pitts, MD
- Family Medicine Physician
- Beaverton, OR
National Provider Identifier
1780756171
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 12287
- Practice address
- 15950 SW Millikan Way
Beaverton, OR 97003-5170 - Phone
- (503) 646-0161
- Fax
- (503) 643-7459
- NPI assigned
- Nov 14, 2006
- Last updated
- Jul 21, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 12287 | OR | Primary |
Addresses
Primary practice location
15950 SW Millikan Way
Beaverton, OR 97003-5170
Mailing address
15950 SW Millikan Way
Beaverton, OR 97003-5170
Phone (503) 646-0161
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 283440 | Medicaid | OR |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12287 | OR | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1780756171",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15950 SW MILLIKAN WAY",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970035170",
"telephone_number": "503-646-0161",
"fax_number": "503-643-7459"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15950 SW MILLIKAN WAY",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970035170",
"telephone_number": "503-646-0161",
"fax_number": "503-643-7459"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PITTS",
"first_name": "RANDOLPH",
"middle_name": "JAMES",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-14",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OR",
"license": "12287",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "283440",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Beaverton, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.