NPIMap

Individual provider Active NPI

Randolph Betts, M.D.

  • Family Medicine Physician
  • Covina, CA
National Provider Identifier
1932113685
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A25707 Issued in CA
Practice address
274 W Badillo St
Covina, CA 91723-1906
Phone
(626) 331-7369
Fax
(626) 967-9869
NPI assigned
Jul 28, 2006
Last updated
Jul 9, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A25707 CA Primary

Addresses

Primary practice location

274 W Badillo St
Covina, CA 91723-1906

Mailing address

PO Box 801463
Santa Clarita, CA 91380-1463
Phone (661) 295-0859

Other identifiers 1

IdentifierTypeStateIssuer
00A257070MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20100728000897 CA Practitioner - Internal Medicine 9537252374 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1962
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

174 W Badillo St
Covina, CA 91723-2015
Phone (626) 331-7369

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A25707CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family Practice Medical Services, Inc. Family Medicine CurrentSince Jul 1, 2010 Accepting new patients
Emanate Health Medical Center Past Accepting new patients
St. Joseph Health Northern California, LLC Past Accepting new patients
Emanate Health Medical Center Past Accepting new patients

Locations

174 W Badillo St
Covina, CA 91723
Phone (626) 331-7369

274 W Badillo St
Covina, CA 91723
Phone (626) 331-7369

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Outreach Home Health Services, IncSouth El Monte, CA, CCN 058294 Home health agency Contracted Managing Employee (5%)
Operational/Managerial Control (5%)		 Sep 1, 2010
Sep 1, 2010

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

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 4

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": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1932113685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 801463",
            "city": "SANTA CLARITA",
            "state": "CA",
            "postal_code": "913801463",
            "telephone_number": "661-295-0859",
            "fax_number": "661-295-0862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "274 W BADILLO ST",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917231906",
            "telephone_number": "626-331-7369",
            "fax_number": "626-967-9869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BETTS",
        "first_name": "RANDOLPH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A25707",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A257070",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Covina, CA

Sources for this page

Verify at the official NPI Registry.