Randolph B Peddicord, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OS6696 Issued in FL

Practice address

1201 SE Indian St
Stuart, FL 34997-5688

Phone

(772) 403-4500

Fax

(772) 403-4500

NPI assigned

Jul 27, 2006

Last updated

Jan 27, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

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.

• Treasure Coast Medical Associates

  dba Stuart Urgent Care

  • Emergency Medicine Physician
  • Jensen Beach, FL
  • NPI 1992791198
  Medicare reassignment
• Coastal Care Corporation

  dba Cleveland Clinic Imaging

  • Magnetic Resonance Imaging (MRI) Clinic/Center
  • Stuart, FL
  • NPI 1366469975
  NPD (past)
• Martin Memorial Medical Center Inc

  dba Cleveland Clinic Martin North, South, Tradition Hospitals

  • Urgent Care Clinic/Center
  • Stuart, FL
  • NPI 1154962918
  NPD (past)
• Martin Memorial Physician Corporation Inc

  • Multi-Specialty Clinic/Center
  • Stuart, FL
  • NPI 1578505228
  NPD (past)

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1296086400000",
    "number": "1841204971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 SE INDIAN ST",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349975688",
            "telephone_number": "772-403-4500",
            "fax_number": "772-403-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 SE INDIAN ST",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349975688",
            "telephone_number": "772-403-4500",
            "fax_number": "772-403-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDDICORD",
        "first_name": "RANDOLPH",
        "middle_name": "B",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2011-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS6696",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "377624700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carlecia Peak
• Julie K Pearson, DC, BS
• Stephanie Ann Pearson
• Caleb John Peck, RBT
• Elizabeth Gladys Pectol, ARNP
• Pediatric Institute for ABA LLC
• Pediatric Institute for Health and Wellness (Adult and Pediatric Institute)
• Pediatrics Care of Stuart,PA
• Pediatrix Medical Group of Florida Inc
• Pediatrix Medical Group of Florida Inc

• Family Medicine Physician in Stuart, FL
• Providers in Stuart, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2011; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.