Randall Lee Funnamark Jr., DO

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

DO3644 Issued in NV

Practice address

10624 S Eastern Ave # a-955
Henderson, NV 89052-2982

Phone

(702) 800-5393

Fax

(702) 407-7016

NPI assigned

May 18, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal Medicine

Education

At Still Un of HLTH Sciences, Col of Osteo Med, Mesa, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Platinum Hospitalists LLPGroup PAC ID 7214076322, 197 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Centennial Hills Hospital Medical Center Hospital, Las Vegas, NV, CCN 290054

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Platinum Hospitalists LLP

  • Hospitalist Physician
  • Henderson, NV
  • NPI 1861627242

  Family Medicine, NV

  Medicare reassignment Care Compare group NPD
• Platinum Hospitalists LLP

  • Internal Medicine Physician
  • Henderson, NV
  • NPI 1437948726

  Family Medicine

  NPD
• Centennial Hills Hospital Medical Center

  • General Acute Care Hospital
  • Las Vegas, NV
  • NPI 1487771812
  NPD (past)
• Spring Valley Medical Center

  • General Acute Care Hospital
  • Las Vegas, NV
  • NPI 1346230323
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Centennial Hills Hospital Medical Center

  • Emergency Care Clinic/Center
  • Las Vegas, NV
  • NPI 1295319085

  Hospital

  Care Compare affiliation
• Centennial Hills Hospital Medical Center

  • General Acute Care Hospital
  • Las Vegas, NV
  • NPI 1487771812

  Hospital

  Care Compare affiliation
• Centennial Hills Hospital Medical Center

  • Emergency Care Clinic/Center
  • Las Vegas, NV
  • NPI 1942991245

  Hospital

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1621296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719187200000",
    "number": "1992379531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10624 S EASTERN AVE # A-955",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890522982",
            "telephone_number": "702-800-5393",
            "fax_number": "702-407-7016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10624 S EASTERN AVE # A-955",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890522982",
            "telephone_number": "702-800-5393",
            "fax_number": "702-407-7016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUNNAMARK",
        "first_name": "RANDALL",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-18",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NV",
            "license": "SL1722",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NV",
            "license": "DO3644",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992379531",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Josephine Fulton
• Margie Noda Funcion
• Functional Neuro Rehab, LLC
• Functional Physical Therapy LLC
• Michelle Funes
• Ashley Furtado
• Daniel Furtado
• Kanako Futa
• FVS Holdings Inc
• FVS Holdings, LTD

• Internal Medicine Physician in Henderson, NV
• Providers in Henderson, NV by specialty
• Internal Medicine Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.