Randall Lane Wilcoxen, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085000632 Issued in IL

Practice address

5114 N Glen Park Place Rd
Peoria, IL 61614-4686

Phone

(309) 683-2402

Fax

(309) 683-2419

NPI assigned

Feb 2, 2006

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Physician Assistant

Practice roles

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.

• Midwest Ear Nose & Throat Associates S.C.

  • Otolaryngology Physician
  • Peoria, IL
  • NPI 1427085620
  NPD (past)
• Proctor Emergency Physicians, P.C.

  • Emergency Medicine Physician
  • Aurora, CO
  • NPI 1912980848
  NPD (past)

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

{
    "created_epoch": "1138838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421971200000",
    "number": "1851363022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5114 N GLEN PARK PLACE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5114 N GLEN PARK PLACE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144686",
            "telephone_number": "309-683-2402",
            "fax_number": "309-683-2419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILCOXEN",
        "first_name": "RANDALL",
        "middle_name": "LANE",
        "name_prefix": "Mr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-02",
        "last_updated": "2015-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085000632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Wigant, APN
• Andrew Wiggers, PT
• Christine Ann Wigginton, MD
• Lori M Wight, D.C.
• Pamela Anne Wilcoxen-Rose, D.C.
• Brett J Wilkerson, MD
• Tamara D Wilkins, APN
• Danette A Wilkinson, ANP
• Debra Lynn Wilkinson, OTR/L
• Ann M Willemsen-Dunlap, CRNA

• All providers in Peoria, IL
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.