Active NPI
Randolph L. Royster Jr., MD
- Therapeutic Radiology Physician
- Clyde, NC
National Provider Identifier
1972553790
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Therapeutic Radiology Physician
- License
- 19717
- Practice address
- 600 Hospital Dr
Suite 10
Clyde, NC 28721-8046 - Phone
- (828) 452-2320
- Fax
- (828) 456-4707
- NPI assigned
- May 11, 2006
- 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 |
|---|---|---|---|---|
| Therapeutic Radiology Physician | 2085R0203X | 19717 | NC | Primary |
Addresses
Primary practice location
600 Hospital Dr
Suite 10
Clyde, NC 28721-8046
Mailing address
2234 Colonial Blvd
Fort Myers, FL 33907-1412
Phone (239) 931-7342
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 130TY | Other | NC | BCBS OF NC PROVIDER # |
| 8770417002 | Other | NC | CIGNA PROVIDER NUMBER |
| 4626651 | Other | NC | AETNA PROVIDER NUMBER |
| 92-0006817 | Other | NC | RAILROAD MCARE PROVIDER # |
| 1190948 | Other | FL | GATEWAY HEALTH |
| 24-00057 | Other | NC | UTD. HLTHCR PROVIDER # |
| 89130TY | Medicaid | NC | |
| B4334 | Other | NC | MEDCOST PROVIDER NUMBER |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19717 | NC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1477526400000",
"number": "1972553790",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2234 COLONIAL BLVD",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339071412",
"telephone_number": "239-931-7342",
"fax_number": "239-931-7385"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 HOSPITAL DR",
"address_2": "SUITE 10",
"city": "CLYDE",
"state": "NC",
"postal_code": "287218046",
"telephone_number": "828-452-2320",
"fax_number": "828-456-4707"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROYSTER",
"first_name": "RANDOLPH",
"middle_name": "L.",
"name_suffix": "Jr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-11",
"last_updated": "2016-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0203X",
"taxonomy_group": "",
"desc": "Radiology, Therapeutic Radiology",
"state": "NC",
"license": "19717",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF NC PROVIDER #",
"identifier": "130TY",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA PROVIDER NUMBER",
"identifier": "8770417002",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PROVIDER NUMBER",
"identifier": "4626651",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MCARE PROVIDER #",
"identifier": "92-0006817",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GATEWAY HEALTH",
"identifier": "1190948",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UTD. HLTHCR PROVIDER #",
"identifier": "24-00057",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "89130TY",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDCOST PROVIDER NUMBER",
"identifier": "B4334",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clyde, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.