Randall E Blome, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD17595 Issued in OR

Practice address

9605 Grand Ronde Rd
Grand Ronde, OR 97347-9712

Phone

(503) 879-2002

Fax

(503) 879-2015

NPI assigned

Apr 18, 2006

Last updated

Oct 16, 2024By the provider in NPPES

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

University of Toledo College of Medicine, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Confederated Tribes of the Grand Ronde Community of OregonGroup PAC ID 6103717277, 17 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Amedisys Home Health Care Home health agency, Salem, OR, CCN 387136
• Willamette Valley Medical Center Hospital, McMinnville, OR, CCN 380071

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: randy.blome.p1@direct.grandronde.nextgenshare.com

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.

• Confederated Tribes of the Grand Ronde Community of Oregon

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Grand Ronde, OR
  • NPI 1174666358

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Confederated Tribes of the Grand Ronde Community of Oregon

  • Land Ambulance
  • Grand Ronde, OR
  • NPI 1215606132
  NPD
• Confederated Tribes of Grand Ronde Community of Oregon Dba GR Health &

  • Community Health Clinic/Center
  • Grand Ronde, OR
  • NPI 1104164359
  NPD (past)

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

• Willamette Valley Medical Center LLC

  dba Willamette Valley Medical Center

  • General Acute Care Hospital
  • McMinnville, OR
  • NPI 1346269982
  Care Compare affiliation

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

{
    "created_epoch": "1145318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729036800000",
    "number": "1861457384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9605 GRAND RONDE RD",
            "city": "GRAND RONDE",
            "state": "OR",
            "postal_code": "973479712",
            "telephone_number": "503-879-2002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9605 GRAND RONDE RD",
            "city": "GRAND RONDE",
            "state": "OR",
            "postal_code": "973479712",
            "telephone_number": "503-879-2002",
            "fax_number": "503-879-2015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOME",
        "first_name": "RANDALL",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-18",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD17595",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA LABOR & INDUSTRIES",
            "identifier": "0200572",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "034558",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maurice A Ajaifia, PMHNP
• Chantel M Allen, APRN
• Katelyn Bailey, ND, LAC
• Maret Banks, MA, LPC, CADC I
• Rachel Sherfey Botelho, DDS
• Mikkell Marie Bowens, DMD
• Laura Ann Burton, CADCII
• Andrew R Canning, PHARMD
• Capitol Physical Therapy, Inc (Capitol Physical and Hand Therapy, Inc)

• Family Medicine Physician in Grand Ronde, OR
• Providers in Grand Ronde, OR by specialty
• Family Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.