Active NPI
Randy Scott Jordan, RPA
- Radiology Practitioner Assistant
- Tulsa, OK
National Provider Identifier
1821355694
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiology Practitioner Assistant
- License
- 279995
- Practice address
- 4500 S Garnett Rd
Tulsa, OK 74146-5229 - Phone
- (918) 728-6194
- Fax
- (918) 664-0267
- NPI assigned
- Apr 18, 2012
- 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 |
|---|---|---|---|---|
| Radiology Practitioner Assistant | 243U00000X | 279995 | OK | Primary |
Addresses
Primary practice location
4500 S Garnett Rd
Tulsa, OK 74146-5229
Mailing address
3227 S 16TH St
Broken Arrow, OK 74012-1801
Phone (918) 728-6194
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 279995 | OK | MD | Radiology Practitioner Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1334707200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1334707200000",
"number": "1821355694",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3227 S 16TH ST",
"city": "BROKEN ARROW",
"state": "OK",
"postal_code": "740121801",
"telephone_number": "918-728-6194",
"fax_number": "918-664-0267"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4500 S GARNETT RD",
"city": "TULSA",
"state": "OK",
"postal_code": "741465229",
"telephone_number": "918-728-6194",
"fax_number": "918-664-0267"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORDAN",
"first_name": "RANDY",
"middle_name": "SCOTT",
"name_prefix": "Mr.",
"credential": "RPA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-04-18",
"last_updated": "2012-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "243U00000X",
"taxonomy_group": "",
"desc": "Radiology Practitioner Assistant",
"state": "OK",
"license": "279995",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tulsa, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.