NPIMap

Individual provider Active NPI

Randall K Booth, MD

  • Anesthesiology Physician
  • Springfield, MO
National Provider Identifier
1871552596
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
101471 Issued in MO
Practice address
3801 S National Ave
Springfield, MO 65807-5210
Phone
(417) 269-6000
NPI assigned
Mar 21, 2006
Last updated
Mar 17, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 101471 MO Primary
Pain Medicine (Anesthesiology) Physician 207LP2900X 101471 MO

Addresses

Primary practice location

3801 S National Ave
Springfield, MO 65807-5210

Mailing address

1000 E Primrose St Ste 520
Springfield, MO 65807-5180

Other practice location 1

800 S Ash St
Nevada, MO 64772-3223
Phone (417) 667-3355

Other identifiers 2

IdentifierTypeStateIssuer
100192010DMedicaidKS
207973231MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20040624000584 MO Practitioner - AnesthesiologyPractitioner - Emergency Medicine 5092791806 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
AnesthesiologyAlso: Emergency Medicine
Education
Creighton University School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ozark Anesthesia Associates IncGroup PAC ID 1850290149, 86 clinicians

Practice addresses (Care Compare)

3801 S National Ave
Springfield, MO 65807-5210
Phone (417) 269-6000

960 E Walnut Lawn St
Cox Surgery Center
Springfield, MO 65807-7506
Phone (417) 225-9235

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
101471MOMDPain Medicine (Anesthesiology) Physician
00000MOMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Advocates for a Healthy Community, Inc CurrentSince Sep 3, 2017 Accepting new patients
Advocates for a Healthy Community Inc CurrentSince Sep 3, 2017 Accepting new patients
Freeman Neosho Hospital Anesthesiology Past Accepting new patients
Robert H and Teresita S Petty Anesthesiology Past Accepting new patients
Joplin Ambulatory Anesthesia Services LLC Past Accepting new patients
Ambulatory Anesthesia Services of Missouri LLC Anesthesiology Past Accepting new patients
Gregory L Hummel MD PC Past Accepting new patients

Locations

440 E Tampa St
Springfield, MO 65806
Phone (417) 831-0191

Interoperability endpoints

  • Direct secure messaging: randall.booth@cernerdirect.coxhealth.com

Organizations & group practices 8

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 3

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": "1142899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1871552596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 E PRIMROSE ST STE 520",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658075180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 S NATIONAL AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658075210",
            "telephone_number": "417-269-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 S Ash St",
            "address_purpose": "LOCATION",
            "city": "Nevada",
            "state": "MO",
            "postal_code": "647723223",
            "country_code": "US",
            "telephone_number": "417-667-3355",
            "fax_number": "417-448-3845",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOOTH",
        "first_name": "RANDALL",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-21",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MO",
            "license": "101471",
            "primary": true
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "MO",
            "license": "101471",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100192010D",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207973231",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

Verify at the official NPI Registry.