Randal Jordan Shumway, DO
Individual provider Active NPI Family Medicine Physician · Snowflake, AZ
NPI 1962027326 · NPPES record last updated Apr 12, 2024
Key facts
- NPI
- 1962027326
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 009441 (AZ)
- Practice address
- 590 S Main Street
Snowflake, AZ 85937-4400 - Phone
- (928) 536-7519
- Fax
- (928) 532-2139
- NPI assigned
- Jun 11, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 9
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Summit Healthcare Medical Associates
Practice addresses (Care Compare)
590 S Main St
Snowflake, AZ 85937-5228
Phone (928) 536-7519
Hospital & facility affiliations
- My Daughters Home Health Agency LLC
- Hospice Compassus - White Mountain
- Summit Healthcare Regional Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220526000658 | AZ | Practitioner - Family Practice | 2264810613 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 009441 | AZ | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Summit Healthcare Medical Associates | Family Medicine | Current | Accepting new patients |
| Summit Healthcare Association | Current | Accepting new patients | |
| Summit Healthcare Medical Associates | Current |
Accepting new patients | |
| Summit Healthcare Medical Associates | Current |
Accepting new patients | |
| Summit Healthcare Association | Past | Accepting new patients |
Locations
2200 E Show Low Lake Rd
Show Low, AZ 85901
Phone (928) 537-4375
590 S Main St
Snowflake, AZ 85937
Phone (520) 536-7519
Interoperability endpoints
- randalshumway@shrmcshma.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 009441 | AZ | Yes |
Addresses
Primary practice location
590 S Main Street
Snowflake, AZ 85937-4400
Mailing address
590 S Main Street
Snowflake, AZ 85937-4400
Phone (928) 536-7519
Other providers in Snowflake, AZ
- Kenneth Floyd Rice
- Jennifer L Rivera
- Danny Roper
- Daniel Rowles
- Don A Shumway
- Sierra Dental, P.C.
- German Antonio Sierra
- Silver Creek Senior Citizen Council
- Mark Skousen
- Bethann Smith
All providers in Snowflake, AZ · Family Medicine Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 12, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.