DR. DERRICK WADE RANDALL (NPI# 1699766758) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699766758 |
| Entity Type | Individual |
| Full Name | DR. DERRICK WADE RANDALL |
| Credential | MD |
| Practice Address |
2145 Henry Tecklenburg Dr Ste 220 Charleston SC 29414-5894 |
| Mailing Address |
Po Box 751649 Charlotte NC 28275-1649 |
| Practice Telephone | 8437238823 |
| Practice Fax Number | 8436068059 |
| Mailing Telephone | 8437891620 |
| Mailing Fax Number | 8437242440 |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2020-09-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207L00000X | Anesthesiology | 19659 | SC | Allopathic & Osteopathic Physicians |
| N | 207L00000X | Anesthesiology | 050251 | GA | Allopathic & Osteopathic Physicians |
| N | 207LP2900X |
Anesthesiology Specialization: Pain Medicine |
19659 | SC | Allopathic & Osteopathic Physicians |
| Y | 208VP0000X |
Pain Medicine Specialization: Pain Medicine |
19659 | SC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | SC LICENSE | 19659 | 01 |
| GA | 000915967B | 05 | |
| SC | 196594 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 18 Oak Forest Rd Ste A, Bluffton, SC 299104990 | 8433101055 | 8433101056 |
| 229 W General Screven Way Ste H-1, Hinesville, GA 313133054 | 9124506300 | 9124506303 |
| 114 Canal St Ste 503, Pooler, GA 313224261 | 9124506300 | 9124506303 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417309329 | Derrick Randall | Optometrist | 600 Ontario St, Storm Lake, IA 50588-1845 | 2016-07-05 |
| 1366828790 | Derrick Randall | Otolaryngology | 2521 Stockton Blvd # 7200, Sacramento, CA 95817-2207 | 2015-08-07 |
| Street Address |
2145 HENRY TECKLENBURG DR STE 220 |
| City | CHARLESTON |
| State | SC |
| Zip Code | 29414-5894 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295245553 | Brooke Jackson Kahn | Physician Assistant | 2145 Henry Tecklenburg Dr Ste 220, Charleston, SC 29414 | 2017-10-01 |
| 1487023263 | Taylor Jessica Callinan | Physician Assistant | 2145 Henry Tecklenburg Dr Ste 220, Charleston, SC 29414-5894 | 2015-09-22 |
| 1720425077 | Melissa L. Woriax | Nurse Practitioner | 2145 Henry Tecklenburg Dr Ste 220, Charleston, SC 29414-5894 | 2013-05-28 |
| 1699041715 | Ryan Wills Uberman | Physician Assistant | 2145 Henry Tecklenburg Dr Ste 220, Charleston, SC 29414-5894 | 2012-03-23 |
| 1912148685 | Roper Saint Francis Physicians Network | Durable Medical Equipment & Medical Supplies | 2145 Henry Tecklenburg Dr Ste 220, Charleston, SC 29414 | 2009-03-10 |
| 1588819205 | Adele Petigru Moore | Nurse Practitioner | 2145 Henry Tecklenburg Dr Ste 220, Charleston, SC 29414-5894 | 2008-11-21 |
| 1770734675 | Robert Morgan Stuart | Neurological Surgery | 2145 Henry Tecklenburg Dr Ste 220, Charleston, SC 29414-5894 | 2008-10-09 |
| 1770591760 | Christopher Stephen Schafer | Physician Assistant | 2145 Henry Tecklenburg Dr Ste 220, Charleston, SC 29414-5894 | 2006-08-04 |
| 1538197306 | Larry Gene Harris | Physician Assistant | 2145 Henry Tecklenburg Dr Ste 220, Charleston, SC 29414-5894 | 2006-06-29 |
| 1801823745 | John Alexander Nicholson | Physical Medicine & Rehabilitation | 2145 Henry Tecklenburg Dr Ste 220, Charleston, SC 29414-5894 | 2006-06-27 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902444508 | Harris Teeter LLC | Durable Medical Equipment & Medical Supplies | 3865 West Ashley Circle, Charleston, SC 29414 | 2019-12-13 |
| 1215440169 | Christine Michelle Delcioppo | Nurse Practitioner | 2085 Henry Tecklenburg Dr Fl 2or2, Charleston, SC 29414 | 2017-11-14 |
| 1871013508 | Carolyn Sorenson | Assistant Behavior Analyst | 2218 Hunter Creek Dr, Charleston, SC 29414 | 2017-06-23 |
| 1205387354 | Rachel Klatt | Physical Therapist | 2230 Ashley Crossing Dr., Charleston, SC 29414 | 2016-10-24 |
| 1295286912 | Mary M Butler | Physical Therapy Assistant | 2230 Ashley Crossing Drive, Charleston, SC 29414 | 2016-10-18 |
| 1295104982 | Charlene Barbot | Registered Nurse | 3741 Clover St, Charleston, SC 29414 | 2015-09-23 |
| 1720467525 | Sasha M. Perez | Family Medicine | 3030 Ashley Town Center Dr Ste 102a, Charleston, SC 29414 | 2015-05-26 |
| 1104226240 | Angela Mcinvale | Counselor | 3030 Ashley Town Center Dr., Bldg. B-203, Charleston, SC 29414 | 2014-08-26 |
| 1659790087 | Catherine Jefferson Vanderwerker | Physical Therapist | 3019 Saintsbury Cove Dr, Charleston, SC 29414 | 2014-04-14 |
| 1104266741 | Elizabeth A Burguieres | Psychiatry & Neurology | Scdmh- Charleston Telepsychiatry Office, 706 Orleans Rd, Charleston, SC 29414 | 2013-06-27 |
| Find all providers in zip 29414 | ||||
| Taxonomy Code | 208VP0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pain Medicine |
| Specialization | Pain Medicine |
| Pain Medicine is a primary medical specialty based on a distinct body of knowledge and a well-defined scope of clinical practice that is founded on science, research and education. It is concerned with the study of pain, the prevention of pain, and the evaluation, treatment, and rehabilitation of persons in pain. A comprehensive evaluation incorporates the physical, psychological, cognitive and socio-cultural contributions to pain. The treatment protocol may include pharmacological, invasive, behavioral, cognitive, rehabilitative and complementary strategies provided in a concurrent focused and patient specific manner. The pain medicine physician often serves the patient as a frontline physician regarding their pain, but also may serve as a consultant to other physicians, direct an interdisciplinary/multidisciplinary treatment team, conduct research, or advocate for the patient’s pain care with public and private agencies. The Pain Medicine physician may work in variety of settings including office, clinic, hospital, university, or governmental/public agencies. |
| Notes: Source: American Academy of Pain Medicine, www.painmed.org - Additional Resources:The American Board of Pain Medicine provides Board Certification. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497128045 | Compass Pain Care LLC | Pain Medicine | 706 Arcadian Way, Charleston, SC 29407-7109 | 2015-11-04 |
| 1376507566 | Josiah Kenneth Lilly IIi | Pain Medicine | 4001 Virginia Ave Se, Charleston, WV 25304-1603 | 2006-04-14 |
| 1790158343 | Compass Pain Care LLC | Pain Medicine | 706 Arcadian Way, Charleston, SC 29407-7109 | 2015-11-04 |
| 1437599206 | Roper Saint Francis Physicians Network | Pain Medicine | 2145 Henry Tecklenburg Dr, Suite 220w, Charleston, SC 29414-5893 | 2013-06-26 |
| 1417929027 | Charleston Spine & Physical Medicine | Pain Medicine | 2093 Henry Tecklenburg Dr, Ste 310, Charleston, SC 29414-5743 | 2006-02-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659915445 | Trident Pain Center P A | Pain Medicine | 176 Mcswain Dr, West Columbia, SC 29169-4825 | 2019-11-05 |
| 1437793353 | Trident Pain Center P A | Pain Medicine | 205 Eddie Chasteen Dr, Walterboro, SC 29488-5728 | 2019-11-04 |
| 1295381291 | Palmetto Bone and Joint | Pain Medicine | 104 Ellett Road, Chapin, SC 29036 | 2019-08-15 |
| 1104472109 | Palmetto Bone and Joint | Pain Medicine | Palmetto Bone and Joint, 2605 Kinard St Suite 105, Newberry, SC 29108 | 2019-08-15 |
| 1194138255 | Trident Pain Center | Pain Medicine | 302 Medical Park Dr Ste 207a, Walterboro, SC 29488-5749 | 2014-06-06 |
| 1679991301 | Hospice & Palliative Care Charlotte Region | Pain Medicine | 1057 Red Ventures Dr, Suite 150, Fort Mill, SC 29707-5001 | 2014-03-31 |
| 1508009614 | Pee Dee Pain Care, LLC | Pain Medicine | 552 W Carolina Ave, Hartsville, SC 29550-5412 | 2009-04-20 |
| 1710151808 | George Calhoun Aycock Jr. | Pain Medicine | 377 Rast St, Sumter, SC 29150-2583 | 2008-04-18 |
| 1356546162 | Leanne Y Watkins | Pain Medicine | 1350 Parkway, Greenwood, SC 29646-3860 | 2007-06-20 |
| 1700833878 | Michael Tannehill Grier | Pain Medicine | 100 Health Way Suite 1260, Piedmont Comprehensive Pain Management Group, Anderson, SC 29621 | 2006-05-27 |
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| City | CHARLESTON |
| Zip Code | 29414 |
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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.