NPIMap

Individual provider Active NPI

Andrew Jerome Randolph, M.D., P.A.

  • Internal Medicine Physician
  • Deland, FL
National Provider Identifier
1982775706
Registry record updated Jul 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
49576 Issued in FL
Practice address
1025 N Stone St
Suite B
Deland, FL 32720-0803
Phone
(386) 734-4453
Fax
(386) 734-1130
NPI assigned
Nov 13, 2006
Last updated
Jul 9, 2010By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 49576 FL Primary

Addresses

Primary practice location

1025 N Stone St
Suite B
Deland, FL 32720-0803

Mailing address

1025 North Stone Street
Suite B
Deland, FL 32720

Other identifiers 4

IdentifierTypeStateIssuer
02590OtherFLPROVIDER #
044348400MedicaidFL
10718618OtherFLCAQH PROVIDER #
592870603OtherFLTAX ID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20110119000755 FL Practitioner - Internal Medicine 1254510597 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1025 N Stone St
Suite B
Deland, FL 32720-0803

1025 N Stone St
Suite B
Deland, FL 32720-3291
Phone (386) 734-4453

701 W Plymouth Ave
Deland, FL 32720-3291
Phone (386) 943-4522

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
49576FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital-West Volusia Inc CurrentSince Oct 13, 1986 Accepting new patients
Memorial Hospital-West Volusia Inc CurrentSince Oct 13, 1986 Accepting new patients
Andrew J. Randolph MD PA Internal Medicine CurrentSince Aug 23, 2010 Accepting new patients
Southwest Volusia Healthcare Corporation Internal Medicine Past Accepting new patients
Southwest Volusia Healthcare Corporation Past Accepting new patients
Jose J Rosales MD PA Past Accepting new patients

Locations

1025 N Stone St
Ste B
Deland, FL 32720
Phone (381) 734-4453

701 W Plymouth Ave
Deland, FL 32720
Phone (386) 943-3160

Interoperability endpoints

  • Direct secure messaging: andrew.randolph.1@19589.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/19589/brand/1/csg/1/fhir/r4

Organizations & group practices 6

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 3

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": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278633600000",
    "number": "1982775706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 NORTH STONE STREET",
            "address_2": "SUITE B",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "32720",
            "fax_number": "386-734-1130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 N STONE ST",
            "address_2": "SUITE B",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327200803",
            "telephone_number": "386-734-4453",
            "fax_number": "386-734-1130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "ANDREW",
        "middle_name": "JEROME",
        "name_prefix": "Dr.",
        "credential": "M.D., P.A.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-13",
        "last_updated": "2010-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "49576",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER #",
            "identifier": "02590",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "044348400",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH PROVIDER #",
            "identifier": "10718618",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "592870603",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Deland, FL

Sources for this page

Verify at the official NPI Registry.