Randall Nesom, MD

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

43413 Issued in OK

Practice address

800 Stanton L Young Blvd
Oklahoma City, OK 73104-5018

Phone

(580) 483-5302

NPI assigned

Nov 10, 2020

Last updated

Jun 4, 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 2

Addresses

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1604966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717459200000",
    "number": "1912509456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 STANTON L YOUNG BLVD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731045018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 STANTON L YOUNG BLVD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731045018",
            "telephone_number": "580-483-5302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NESOM",
        "first_name": "RANDALL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-11-10",
        "last_updated": "2024-06-04",
        "certification_date": "2024-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "OK",
            "license": "43413",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Urology Physician in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Urology Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.