Active NPI
Randolph S. Powers, M.D.
- Geriatric Medicine (Family Medicine) Physician
- Peabody, MA
National Provider Identifier
1962407536
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Medicine (Family Medicine) Physician
- License
- 80799
- Practice address
- 100 Brooksby Village Dr
Peabody, MA 01960-1438 - Phone
- (978) 536-7850
- Fax
- (877) 280-9727
- NPI assigned
- Jun 20, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Medicine (Family Medicine) Physician | 207QG0300X | 80799 | MA | Primary |
Addresses
Primary practice location
100 Brooksby Village Dr
Peabody, MA 01960-1438
Mailing address
100 Brooksby Village Dr
Peabody, MA 01960-1438
Phone (978) 536-7850
Other identifiers 15
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00602018 | Other | RAILROAD MEDICARE | |
| 30205089 | Other | NH | NEW HAMPSHIRE MEDICAID |
| J31185 | Other | MA | BLUE CROSS BLUE SHIELD |
| 1962407536 | Other | BCBS | |
| 3139298 | Medicaid | MA | |
| AA32263 | Other | MA | HARVARD PILGRIM HEALTHCAR |
| B07616 | Other | NH | ANTHEM BLUE CROSS |
| 0132658 | Other | MA | EVERCARE |
| 07-02617 | Other | EVERCARE | |
| 0016036 | Other | NEIGHBORHOOD HEALTH PLAN | |
| 1440628 | Other | CIGNA | |
| 1440628 | Other | HEALTHSOURCE | |
| P00228069 | Other | RAILROAD MEDICARE | |
| 080799 | Other | MA | TUFTS HEALTH PLAN |
| 968005 | Other | NETWORK HEALTH |
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
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1306195200000",
"number": "1962407536",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 BROOKSBY VILLAGE DR",
"city": "PEABODY",
"state": "MA",
"postal_code": "019601438",
"telephone_number": "978-536-7850",
"fax_number": "877-280-9727"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 BROOKSBY VILLAGE DR",
"city": "PEABODY",
"state": "MA",
"postal_code": "019601438",
"telephone_number": "978-536-7850",
"fax_number": "877-280-9727"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POWERS",
"first_name": "RANDOLPH",
"middle_name": "S.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-20",
"last_updated": "2011-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "207QG0300X",
"taxonomy_group": "",
"desc": "Family Medicine, Geriatric Medicine",
"state": "MA",
"license": "80799",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00602018",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEW HAMPSHIRE MEDICAID",
"identifier": "30205089",
"state": "NH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "J31185",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "1962407536",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3139298",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM HEALTHCAR",
"identifier": "AA32263",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BLUE CROSS",
"identifier": "B07616",
"state": "NH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EVERCARE",
"identifier": "0132658",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EVERCARE",
"identifier": "07-02617",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEIGHBORHOOD HEALTH PLAN",
"identifier": "0016036",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "1440628",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHSOURCE",
"identifier": "1440628",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00228069",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS HEALTH PLAN",
"identifier": "080799",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NETWORK HEALTH",
"identifier": "968005",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Peabody, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.