Individual provider Active NPI

Randall W McCarthy, P.A.

  • Medical Physician Assistant
  • Waycross, GA
National Provider Identifier
1891875878
Registry record updated Jun 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
000666 Issued in GA
Practice address
711 Knight Ave
Waycross, GA 31501-1943
Phone
(912) 283-9423
Fax
(912) 283-2946
NPI assigned
Oct 16, 2006
Last updated
Jun 11, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 000666 GA Primary

Addresses

Primary practice location

711 Knight Ave
Waycross, GA 31501-1943

Mailing address

711 Knight Ave
Waycross, GA 31501-1943
Phone (912) 283-9423

Other identifiers 3

IdentifierTypeStateIssuer
476568664AMedicaidGA
1891875878OtherGAMEDICARE NPI
CG6045OtherGARAILROAD MEDICARE GROUP ID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070425000015 GA Practitioner - Physician Assistant 3476658196 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Medical College of Georgia School of Medicine, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Internal Medicine Associates of Waycross P.C.Group PAC ID 0749276004, 5 clinicians

Practice addresses (Care Compare)

711 Knight Ave
Waycross, GA 31501-1943
Phone (912) 283-9423

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
000666GAMDMedical Physician Assistant

Interoperability endpoints

  • Direct secure messaging: randall.mccarthy@gwim.eclinicaldirectplus.com

Organizations & group practices 1

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 1

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": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623369600000",
    "number": "1891875878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 KNIGHT AVE",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315011943",
            "telephone_number": "912-283-9423",
            "fax_number": "912-283-2946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 KNIGHT AVE",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315011943",
            "telephone_number": "912-283-9423",
            "fax_number": "912-283-2946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCARTHY",
        "first_name": "RANDALL",
        "middle_name": "W",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-16",
        "last_updated": "2021-06-11",
        "certification_date": "2021-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "000666",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "476568664A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NPI",
            "identifier": "1891875878",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP ID",
            "identifier": "CG6045",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waycross, GA

Sources for this page

Verify at the official NPI Registry.