Active NPI
Randall C Cork, M.D.
- Anesthesiology Physician
- Shreveport, LA
National Provider Identifier
1851471528
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 09580R
- Practice address
- 1501 Kings Hwy
Shreveport, LA 71103-4228 - Phone
- (318) 675-5581
- NPI assigned
- Oct 17, 2006
- 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 |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 09580R | LA | Primary |
Addresses
Primary practice location
1501 Kings Hwy
Shreveport, LA 71103-4228
Mailing address
1501 Kings Hwy
Shreveport, LA 71103-4228
Phone (318) 675-5581
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1978833 | Medicaid | LA | |
| 021774 | Other | CDS |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 09580R | LA | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lsu Medical Center | Past | Accepting new patients | |
| Louisiana State University School of Medicine in New Orleans Faculty G | Past | Accepting new patients |
Organizations & group practices 2
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.
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- NPI 1588737803
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1851471528",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1501 KINGS HWY",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711034228",
"telephone_number": "318-675-5581"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 KINGS HWY",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711034228",
"telephone_number": "318-675-5581"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORK",
"first_name": "RANDALL",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-17",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "LA",
"license": "09580R",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1978833",
"state": "LA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CDS",
"identifier": "021774",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.