RANDOLPH MEDICAL PRACTICES PA (NPI# 1144320052) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144320052 |
| Entity Type | Organization |
| Organization Name | RANDOLPH MEDICAL PRACTICES PA |
| Practice Address |
1847 Sw Barnett Way Lake City FL 32025-6957 |
| Practice Telephone | 3867551440 |
| Practice Fax Number | 3867585628 |
| Mailing Telephone | 3867551440 |
| Mailing Fax Number | 3867585628 |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2018-10-31 |
| Authorized Official Name | TOMMY LAVAUGHN RANDOLPH (MD) |
| Authorized Official Telephone | 3867551440 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208000000X | Pediatrics | ME51982 | FL | Allopathic & Osteopathic Physicians |
| Y | 207Q00000X | Family Medicine | ME46235 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | BCBS GROUP NUMBER | 38690 | 01 |
| FL | 256113100 | 05 |
| Street Address |
1847 SW BARNETT WAY |
| City | LAKE CITY |
| State | FL |
| Zip Code | 32025-6957 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346249406 | Matthew Neil Melvin | Nurse Practitioner | 1847 Sw Barnett Way, Lake City, FL 32025-6957 | 2005-07-20 |
| 1356500987 | Milla Pediatrics and Associates, Inc | Pediatrics | 1847 Sw Barnett Way, Lake City, FL 32025-6957 | 2008-06-09 |
| 1386726578 | Milla Pediatrics & Associates, Inc. | Pediatrics | 1847 Sw Barnett Way, Lake City, FL 32025-6957 | 2006-10-19 |
| 1972603876 | Athena R Randolph | Pediatrics | 1847 Sw Barnett Way, Lake City, FL 32025-6957 | 2006-09-22 |
| 1992805881 | Tommy Lavaughn Randolph | Family Medicine | 1847 Sw Barnett Way, Lake City, FL 32025-6957 | 2006-09-22 |
| 1639179435 | Johnna L Jackson | Nurse Practitioner | 1847 Sw Barnett Way, Lake City, FL 32025 | 2005-07-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801438353 | Jennifer Bennett | Pharmacist | 347 Sw Main Blvd Suite 102, Lake City, FL 32025 | 2019-10-16 |
| 1700352838 | Robert J Sansouci IIi IIi | Physical Therapy Assistant | 560 Sw Mcfarlane Ave, Lake City, Fl, 32025, Lake City, FL 32025 | 2018-10-16 |
| 1316442783 | Emily Bailey | Developmental Therapist | 2126 Sw Sisters Welcome Rd, Lake City, FL 32025 | 2018-03-28 |
| 1811446370 | Michelle Hart | Behavioral Analyst | 260 S. Marion Avenue, Bldg. A, Suite 135, Lake City, FL 32025 | 2016-09-26 |
| 1922467646 | Irene Aponte Moreno | Nurse Practitioner | 440 Sw Perimeter Glen, Lake City, FL 32025 | 2016-02-23 |
| 1093186777 | Decarlos Scippio | Counselor | 619 Sw Baya Drive Suite 102, Lake City, FL 32025 | 2015-10-07 |
| 1497132476 | Jamecia Legree | Registered Nurse | 800 Sw Symphony Loop, Bldg 15 Apt 204, Lake City, FL 32025 | 2015-04-29 |
| 1306249149 | Mercy Home Assisted Living Facility LLC | Assisted Living Facility | 184 S.e. Beech Street, Lake City, FL 32025 | 2014-10-08 |
| 1598174344 | Karen Mcdonald | Developmental Therapist | 4523 Se County Road 252, Lake City, FL 32025 | 2014-08-06 |
| 1275944126 | Mohammad Ali Faisal Mdpa | Specialist | 1283 Sw State Rd 47, Ste 104, Lake City, FL 32025 | 2014-05-14 |
| Find all providers in zip 32025 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538655766 | Silver Thread Public Health District | Family Medicine | 304 W. 3rd St, Lake City, CO 81235-0277 | 2018-07-11 |
| 1467814582 | Osayamen O Omoruyi | Family Medicine | 4784 W Us Highway 90, Lake City, FL 32055-3101 | 2016-03-28 |
| 1255698619 | Osayande Stephen Izeiyamu | Family Medicine | 194 Sw Wall Ter, Lake City, FL 32025-5086 | 2012-04-23 |
| 1811206923 | Riverside Medical Clinic | Family Medicine | 803 Hwy 18, Lake City, AR 72347-0505 | 2010-10-07 |
| 1508181272 | Dynamic Health Centers | Family Medicine | 163 Sw Stonegate Ter Ste 109, Lake City, FL 32024-3459 | 2010-04-06 |
| 1659506699 | Live Oak Medical Center, Pa | Family Medicine | 148 Sauls St., Lake City, SC 29560 | 2009-05-20 |
| 1871776732 | Javier D Amador | Family Medicine | 484 Sw Commerce Dr Ste 140, Lake City, FL 32025-1588 | 2007-12-13 |
| 1699838003 | Peter Wendell Giebeig Jr. | Family Medicine | 5085 West Us Hwy 90, Lake City, FL 32055 | 2006-12-18 |
| 1568544054 | Miguel Jose Tepedino | Family Medicine | 1717 Sw Newland Way, Lake City, FL 32025-6966 | 2006-10-20 |
| 1801992599 | Morris E Brown IIi | Family Medicine | 901 N. Matthews Road, Lake City, SC 29560-7024 | 2006-09-16 |
| Find all providers in LAKE CITY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.