Carrie Linda Randall, P.A.-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

1077570 Issued in OK

Practice address

1505 E Main St
Stigler Health and Wellness
Stigler, OK 74462-2913

Phone

(918) 967-3368

Fax

(918) 967-3351

NPI assigned

Sep 13, 2007

Sex

Female

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 1

Medicare fee-for-service enrollment

Enrolled in OK

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/2d405cde-1d8b-4a50-adff-ca7776cd856e/

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.

• Stigler Health and Wellness Center Inc

  • Federally Qualified Health Center (FQHC)
  • Stigler, OK
  • NPI 1891752853
  Medicare reassignment NPD
• Cherokee Nation

  • Public Health or Welfare Agency
  • Tahlequah, OK
  • NPI 1013884154
  NPD (past)
• Cherokee Nation

  • Multi-Specialty Clinic/Center
  • Tahlequah, OK
  • NPI 1093722324
  NPD (past)
• Tracey W. Childers, D.O. P.C.

  • Otolaryngology Physician
  • Tahlequah, OK
  • NPI 1720274699
  NPD (past)

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

{
    "created_epoch": "1189641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435276800000",
    "number": "1891980728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2525 CHANDLER RD",
            "city": "MUSKOGEE",
            "state": "OK",
            "postal_code": "744035088",
            "telephone_number": "918-681-7533",
            "fax_number": "918-684-9033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 E MAIN ST",
            "address_2": "STIGLER HEALTH AND WELLNESS",
            "city": "STIGLER",
            "state": "OK",
            "postal_code": "744622913",
            "telephone_number": "918-967-3368",
            "fax_number": "918-967-3351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDALL",
        "first_name": "CARRIE",
        "middle_name": "LINDA",
        "name_prefix": "Mrs.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-13",
        "last_updated": "2015-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OK",
            "license": "1077570",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200122650A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Crystal Portugal
• Tara Potts, APRN
• Kaitlen Elizabeth Pryor
• Psychiatric and Addiction Centered Medicine LLC
• Amanda Rainbolt
• Leslie Ratliff
• Melissa Reading, BA
• Beth Reese, LMSW
• Emily J Renfrow, LMFT
• Jana Kathleen Reynolds, LMSW-P

• Medical Physician Assistant in Stigler, OK
• Providers in Stigler, OK by specialty
• Medical Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2015; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.