NPIMap

Individual provider Active NPI

William John Randall, MD

  • Family Medicine Physician
  • Kettering, OH
National Provider Identifier
1851355630
Registry record updated Jul 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35.059106 R Issued in OH
Practice address
1900 Composite Drive
Kettering, OH 45420-1475
Phone
(937) 293-8419
Fax
(937) 293-1545
NPI assigned
Apr 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35.059106 R OH Primary

Addresses

Primary practice location

1900 Composite Drive
Kettering, OH 45420-1475

Mailing address

25 Merchant Street
Suite 220
Cincinnati, OH 45246-3740
Phone (513) 533-6507

Other identifiers 1

IdentifierTypeStateIssuer
0827967MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100317000294 OH Practitioner - Family Practice 2567597420 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Cincinnati College of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1900 Composite Dr
Kettering, OH 45420-1475
Phone (937) 293-8419

Hospital & facility affiliations

  • Kettering Homecare Home health agency, Kettering, OH, CCN 367778
  • Fidelity Health Care Home health agency, Moraine, OH, CCN 367160
  • Miami Valley Hospital Hospital, Dayton, OH, CCN 360051
  • Kettering Health Main Campus Hospital, Kettering, OH, CCN 360079
  • Kettering Health Dayton Hospital, Dayton, OH, CCN 360133
  • Kettering Health Miamisburg Hospital, Miamisburg, OH, CCN 360239
  • Soin Medical Center Hospital, Beaver Creek, OH, CCN 360360

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35.059106 ROHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Integrated Medical Assoc LTD Family Medicine CurrentSince Apr 16, 2001 Accepting new patients
Premier Integrated Medical Assoc LTD Family Medicine CurrentSince Apr 16, 2001 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

25 Merchant St
Ste 220
Cincinnati, OH 45246

6611 Clyo Rd
Dayton, OH 45459
Phone (937) 208-8282

948 Patterson Rd
Dayton, OH 45419
Phone (614) 412-1789

7211 N Main St
Ste 1
Englewood, OH 45415
Phone (937) 274-2117

1900 Composite Dr
Kettering, OH 45420
Phone (937) 293-8419

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1145232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437523200000",
    "number": "1851355630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 MERCHANT STREET",
            "address_2": "SUITE 220",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452463740",
            "telephone_number": "513-533-6507",
            "fax_number": "513-645-9767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 COMPOSITE DRIVE",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454201475",
            "telephone_number": "937-293-8419",
            "fax_number": "937-293-1545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDALL",
        "first_name": "WILLIAM",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-17",
        "last_updated": "2015-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35.059106 R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0827967",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kettering, OH

Sources for this page

Verify at the official NPI Registry.