Individual provider Active NPI

Guy P. Randazzo, M.D.

  • Pulmonary Disease Physician
  • Tustin, CA
National Provider Identifier
1881663979
Registry record updated Mar 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
A22452 Issued in CA
Practice address
13522 Newport Ave Ste 102
Tustin, CA 92780-3707
Phone
(714) 573-8200
Fax
(714) 573-9401
NPI assigned
Mar 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X A22452 CA Primary

Addresses

Primary practice location

13522 Newport Ave Ste 102
Tustin, CA 92780-3707

Mailing address

PO Box 15090
Anaheim, CA 92803-5090
Phone (714) 577-2124

Other identifiers 2

IdentifierTypeStateIssuer
CB292883MedicaidCA
1912919804MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20081230000543 CA Practitioner - Internal MedicinePractitioner - Pulmonary Disease 6608847611 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Chest and Critical Care Consultants Pulmonary Disease CurrentSince Feb 21, 2018 Accepting new patients
Chest and Critical Care Consultants a Medical Group Pulmonary Disease Current Accepting new patients

Locations

13522 Newport Ave
Ste 102
Tustin, CA 92780
Phone (714) 573-8200

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.

NPI Registry JSON

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585526400000",
    "number": "1881663979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15090",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928035090",
            "telephone_number": "714-577-2124",
            "fax_number": "714-577-2125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13522 NEWPORT AVE STE 102",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927803707",
            "telephone_number": "714-573-8200",
            "fax_number": "714-573-9401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDAZZO",
        "first_name": "GUY",
        "middle_name": "P.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-14",
        "last_updated": "2020-03-30",
        "certification_date": "2020-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "CA",
            "license": "A22452",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CB292883",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1912919804",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tustin, CA

Sources for this page

Verify at the official NPI Registry.