NPIMap

Individual provider Active NPI

Randolph Chu Villamor, MD

  • Internal Medicine Physician
  • Rock Hill, SC
National Provider Identifier
1851383731
Registry record updated Oct 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
24083 Issued in SC
Practice address
311 Glenwood Dr
Rock Hill, SC 29732-1818
Phone
(880) 336-6717
Fax
(803) 366-0529
NPI assigned
Aug 17, 2005
Last updated
Oct 13, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 24083 SC Primary

Addresses

Primary practice location

311 Glenwood Dr
Rock Hill, SC 29732-1818

Mailing address

311 Glenwood Dr
Rock Hill, SC 29732-1818
Phone (880) 336-6717

Other identifiers 1

IdentifierTypeStateIssuer
240830MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20031210000836 SC Practitioner - Internal Medicine 9436055365 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Piedmont Physician Network LLCGroup PAC ID 7911287552, 92 clinicians
Cora South Carolina LLCGroup PAC ID 3173766334, shared by 6 NPIs, 220 clinicians

Practice addresses (Care Compare)

200 Herlong Ave S
Rock Hill, SC 29732-1182

311 Glenwood Dr
Rock Hill, SC 29732-1818
Phone (803) 366-7175

851 Heckle Blvd
Suite 115
Rock Hill, SC 29730-2806
Phone (839) 388-0908

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Piedmont Physician Network LLC Internal Medicine CurrentSince Oct 2, 2023 Accepting new patients
Carolina Medical Consultants PA Internal Medicine CurrentSince Jan 1, 2004 Accepting new patients
Piedmont East Urgent Care Center LLC PastSince Sep 3, 2013 Accepting new patients
Chicot Memorial Hospital Past Accepting new patients
Piedmont Urgent Care Center at Baxter Village LLC Past Accepting new patients

Locations

502 6th Baxter Xing
Fort Mill, SC 29708
Phone (803) 396-8100

200 Herlong Ave S
Ste E
Rock Hill, SC 29732
Phone (803) 324-1950

311 Glenwood Dr
Rock Hill, SC 29732
Phone (803) 366-7175

760 Addison Dr
Rock Hill, SC 29730
Phone (803) 329-1930

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14929/brand/3/csg/1/fhir/r4
  • FHIR API: https://api.platform.athenahealth.com/22888/brand/1/csg/1/fhir/r4
  • Direct secure messaging: randolph.villamor.1@14929.direct.athenahealth.com

Organizations & group practices 5

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.

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": "1124236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697155200000",
    "number": "1851383731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 GLENWOOD DR",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297321818",
            "telephone_number": "880-336-6717",
            "fax_number": "803-366-0529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 GLENWOOD DR",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297321818",
            "telephone_number": "880-336-6717",
            "fax_number": "803-366-0529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VILLAMOR",
        "first_name": "RANDOLPH",
        "middle_name": "CHU",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-17",
        "last_updated": "2023-10-13",
        "certification_date": "2023-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "24083",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "240830",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rock Hill, SC

Sources for this page

Verify at the official NPI Registry.