NPIMap

Organization Active NPI

Town of Randolph

  • Land Ambulance
  • Randolph, MA
National Provider Identifier
1790834141
Registry record updated Jun 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
Legal business name
TOWN OF RANDOLPH
Practice address
10 Memorial Parkway
Randolph, MA 02368-4537
Phone
(781) 961-0992
Fax
(781) 961-3473
NPI assigned
Jan 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2020

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

Authorized official

Name
Mr. Richard Donovan
Title
Chief of Department
Phone
(781) 961-0992

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Land Ambulance 3416L0300X Primary

Addresses

Primary practice location

10 Memorial Parkway
Randolph, MA 02368-4537

Mailing address

19 Norfolk Ave Ste B
South Easton, MA 02375-1911
Phone (888) 771-6115

Other identifiers 1

IdentifierTypeStateIssuer
1701274MedicaidMA

Other names 1

  • Randolph Fire Department Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070827000420 MA Part B Supplier - Ambulance Service Supplier 6103836739 Practice locations: Randolph, MA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
22D2319004Town of Randolph Fire Department10 Memorial Parkway, Randolph, MA 02368Certificate of waiverFeb 20, 2027

National Provider Directory

National Provider Directory
Tax ID family
Town of Randolph3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

10 Memorial Pkwy
Randolph, MA 02368
Phone (781) 961-0991

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592352000000",
    "number": "1790834141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 NORFOLK AVE STE B",
            "city": "SOUTH EASTON",
            "state": "MA",
            "postal_code": "023751911",
            "telephone_number": "888-771-6115",
            "fax_number": "508-297-2699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 MEMORIAL PARKWAY",
            "city": "RANDOLPH",
            "state": "MA",
            "postal_code": "023684537",
            "telephone_number": "781-961-0992",
            "fax_number": "781-961-3473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOWN OF RANDOLPH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2020-06-17",
        "certification_date": "2020-06-17",
        "status": "A",
        "authorized_official_last_name": "DONOVAN",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "CHIEF OF DEPARTMENT",
        "authorized_official_telephone_number": "781-961-0992",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1701274",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Randolph Fire Department",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Randolph Fire Department",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Randolph, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2020; 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.