Individual provider Active NPI

Leah Randiak, PA-C

  • Physician Assistant
  • Silver Spring, MD
National Provider Identifier
1952735649
Registry record updated May 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C05075 Issued in MD
Practice address
1500 Forest Glen Rd
Silver Spring, MD 20910
Phone
(301) 754-7000
NPI assigned
Aug 29, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 28, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C05075 MD Primary

Addresses

Primary practice location

1500 Forest Glen Rd
Silver Spring, MD 20910

Mailing address

3421 Winmoor Dr
Ijamsville, MD 21754-9547

Other practice location 1

18566 Office Park Dr
Montgomery Village, MD 20886-0587
Phone (301) 769-6640

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C05075MDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Frederick Health Hospital Inc Past Accepting new patients
Inpatient Consultants of Maryland, P.C. Physician Assistant Past Accepting new patients

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": "1377734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527465600000",
    "number": "1952735649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3421 WINMOOR DR",
            "city": "IJAMSVILLE",
            "state": "MD",
            "postal_code": "217549547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 FOREST GLEN RD",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "20910",
            "telephone_number": "301-754-7000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18566 Office Park Dr",
            "address_purpose": "LOCATION",
            "city": "Montgomery Village",
            "state": "MD",
            "postal_code": "208860587",
            "country_code": "US",
            "telephone_number": "301-769-6640",
            "fax_number": "301-769-6650",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RANDIAK",
        "first_name": "LEAH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-29",
        "last_updated": "2018-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C05075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Silver Spring, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.