Active NPI
Randy Meredith
- Emergency Registered Nurse
- San Diego, CA
National Provider Identifier
1851960587
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Registered Nurse
- License
- 95030170
- Practice address
- 908 Thomas Ave
San Diego, CA 92109-4022 - Phone
- (626) 827-8844
- NPI assigned
- Jun 17, 2021
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Emergency Registered Nurse | 163WE0003X | 95030170 | CA | Primary |
Addresses
Primary practice location
908 Thomas Ave
San Diego, CA 92109-4022
Mailing address
908 Thomas Ave
San Diego, CA 92109-4022
Phone (626) 827-8844
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95030170 | CA | MD | Primary Care Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623888000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623888000000",
"number": "1851960587",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "908 THOMAS AVE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921094022",
"telephone_number": "626-827-8844"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "908 THOMAS AVE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921094022",
"telephone_number": "626-827-8844"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEREDITH",
"first_name": "RANDY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-06-17",
"last_updated": "2021-06-17",
"certification_date": "2021-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "163WE0003X",
"taxonomy_group": "",
"desc": "Registered Nurse, Emergency",
"state": "CA",
"license": "95030170",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.