RANDOLPH COMMUNITY CLINIC SC (NPI# 1497832257) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497832257 |
| Entity Type | Organization |
| Organization Name | RANDOLPH COMMUNITY CLINIC SC |
| Practice Address |
504 S High Street Randolph WI 53956 |
| Mailing Address |
504 S High St Po Box 101 Randolph WI 53956-1499 |
| Practice Telephone | 9203265060 |
| Practice Fax Number | 9203265061 |
| Mailing Telephone | 9203265060 |
| Mailing Fax Number | 9203265061 |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2008-04-20 |
| Authorized Official Name | MELISSA ELAINE LUCARELLI (PRESIDENT) |
| Authorized Official Telephone | 9203265060 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 36988020 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 32327000 | 05 | |
| RAILROAD MEDICARE | CH8761 | 01 | |
| DEAN HEALTH PLAN | N96 | 01 |
| Street Address |
504 S HIGH STREET |
| City | RANDOLPH |
| State | WI |
| Zip Code | 53956 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336102169 | Melissa Elaine Lucarelli | Family Medicine | 504 S High Street, Randolph, WI 53956 | 2006-04-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194778324 | Shannon N Sandstrom | Nurse Practitioner | 137 Cambria St, Randolph, WI 53956 | 2006-05-18 |
| 1811039761 | Consultants Laboratory of Wi, LLC | Clinical Medical Laboratory | 137 Cambria St, Randolph, WI 53956 | 2007-02-13 |
| 1770529828 | Agnesian Healthcare | Durable Medical Equipment & Medical Supplies | 137 Cambria St, Randolph, WI 53956 | 2006-06-20 |
| 1962052548 | Tessa Lindner | Physical Therapist | 502 N High St, Randolph, WI 53956-1117 | 2019-09-16 |
| 1245646645 | Rebecca Yelle | Occupational Therapist | 509 Williams St, Randolph, WI 53956-1122 | 2014-07-07 |
| 1003959529 | James Leslie Jones | Chiropractor | 175 Stark St, Randolph, WI 53956-1243 | 2007-02-14 |
| 1801955950 | Ross D Werner | Dentist | 125 N High St, Randolph, WI 53956-1267 | 2006-12-06 |
| 1356383822 | Md Group II LLC | Durable Medical Equipment & Medical Supplies | 107 N High St, Randolph, WI 53956-1267 | 2006-06-11 |
| 1457961971 | Myriel Jamae Werner | Dentist | 125 N High St, Randolph, WI 53956-1267 | 2020-08-10 |
| 1154711190 | Randolph Family Dental LLC | Dentist | 125 N High St, Randolph, WI 53956-1267 | 2015-01-29 |
| Find all providers in zip 53956 | ||||
| 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 |
|---|---|---|---|---|
| 1982101309 | Essex County Weightloss, LLC | Family Medicine | 81 State Road 10 East, Randolph, NJ 07869 | 2018-04-11 |
| 1265808265 | Nicole Alexis Lopez | Family Medicine | 32 S Main St Ste 100, Randolph, MA 02368-4835 | 2015-08-13 |
| 1942596358 | Gary S. Safier Do, PC | Family Medicine | 477 Route 10 E Ste 204, Randolph, NJ 07869-2144 | 2011-06-23 |
| 1346331717 | Susan M Palmer | Family Medicine | 714 Route 10 W, Randolph, NJ 07869-2058 | 2006-09-28 |
| 1558478529 | Gary S Safier | Family Medicine | 477 Rt 10 E, St 204, Randolph, NJ 07869 | 2006-08-24 |
| 1336102169 | Melissa Elaine Lucarelli | Family Medicine | 504 S High Street, Randolph, WI 53956 | 2006-04-11 |
| 1164416228 | Carmel M Kelly | Family Medicine | 1093 N Main St, Randolph, MA 02368-2100 | 2005-09-06 |
| 1538666946 | Mw Wellness Vii, LLC | Family Medicine | 81 State Road 10 East, Randolph, NJ 07869 | 2018-04-11 |
| 1326434713 | Emilija O Florance | Family Medicine | 44 S Main St, Randolph, VT 05060 | 2015-04-13 |
| 1609271493 | Dora Leibu | Family Medicine | 477 Route 10 E, Randolph, NJ 07869-2142 | 2014-10-23 |
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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.