Crystal A Randolph, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

39321 Issued in TX

Practice address

8500 Village Dr Ste 101
San Antonio, TX 78217-5510

Phone

(726) 201-3047

Fax

(833) 629-0318

NPI assigned

Oct 18, 2018

Last updated

Mar 23, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX, FL, LA, NC, OH, OK6 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 6

Specialty

Clinical Social Worker

Education

Other, 2003

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: crystal.randolph.1@21505.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/14727/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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Eleanor Health Professional TX, PLLC

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • San Antonio, TX
  • NPI 1932854981
  Medicare reassignment NPD
• Insight Mental Wellness PA

  • Psychiatry Physician
  • San Antonio, TX
  • NPI 1598243479
  Medicare reassignment NPD
• Eleanor Health Professional la, LLC

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • Lafayette, LA
  • NPI 1265050736
  Medicare reassignment NPD
• Eleanor Health Professional NC, PLLC

  • Psychiatry Physician
  • Hickory, NC
  • NPI 1891349155
  Medicare reassignment NPD
• Eleanor Health Professional Oh, LLC

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • Akron, OH
  • NPI 1730782475
  Medicare reassignment NPD
• Eleanor Health Professional TX PLLC

  • Psychiatry Physician
  • Oklahoma City, OK
  • NPI 1013707587
  Medicare reassignment
• Eleanor Health Professional TX, PLLC

  • Addiction Psychiatry Physician
  • Denver, CO
  • NPI 1891583480
  NPD
• Functional Neurorestoration Institute PLLC

  • Internal Medicine Physician
  • San Antonio, TX
  • NPI 1245736024
  NPD (past)
• Ikare Mood Trauma Recovery Clinic

  • Psychiatry Physician
  • San Antonio, TX
  • NPI 1003361635
  NPD (past)
• Medvon Medical Clinic Professional Corporation

  • Internal Medicine Physician
  • San Antonio, TX
  • NPI 1407513443
  NPD (past)

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

{
    "created_epoch": "1539820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679529600000",
    "number": "1811463797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 CRESCENT ST STE 202",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024533425",
            "telephone_number": "781-487-1107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8500 VILLAGE DR STE 101",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782175510",
            "telephone_number": "726-201-3047",
            "fax_number": "833-629-0318"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8401 Datapoint Dr Ste 900",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782295385",
            "country_code": "US",
            "telephone_number": "210-301-0125",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "CRYSTAL",
        "middle_name": "A",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-18",
        "last_updated": "2023-03-23",
        "certification_date": "2023-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "39321",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Latiffia Randle
• Cheryl Kirby Randol, D.D.S.
• Macie Randol, RN, BSN
• Amanda Christine Randolph, MD, PHD
• Briana Patricia Randolph
• Gregory Dwight Randolph, DDS
• Henry Randolph, LPC
• Jennifer Vela Randow, M.S., L.P.C.
• Robert Ewing Raney Jr., D.D.S.
• Jeanette Rangel de Los Reyes, OTR

• Clinical Social Worker in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.