DR. JACOB RUSSELL RANDICH (NPI# 1922668755) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1922668755 |
Entity Type | Individual |
Full Name | DR. JACOB RUSSELL RANDICH |
Credential | DPM |
Practice Address |
5666 E State St Rockford IL 61108-2425 |
Mailing Address |
646 Vine St Hampshire IL 60140-5620 |
Practice Telephone | 8152262000 |
Mailing Telephone | 6303378353 |
Enumeration Date | 2019-06-14 |
Last Update Date | 2019-06-14 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 213E00000X | Podiatrist | 135.001050 | IL | Podiatric Medicine & Surgery Service Providers |
Street Address |
5666 E STATE ST |
City | ROCKFORD |
State | IL |
Zip Code | 61108-2425 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1508849209 | Richard Emery Freeman | Neurological Surgery | 5666 E State St, Rockford, IL 61108-2425 | 2005-11-28 |
1881293348 | Salman Nafees | Nurse Anesthetist, Certified Registered | 5666 E State St, Rockford, IL 61108-2425 | 2020-10-25 |
1346856424 | Keely K Zunker | Nurse Practitioner | 5666 E State St, Rockford, IL 61108-2472 | 2020-09-23 |
1962026476 | Angie Youssef Hernandez | Student in an Organized Health Care Education/Training Program | 5666 E State St, Rockford, IL 61108-2425 | 2020-06-01 |
1568085710 | Kelsey Surowiec | Student in an Organized Health Care Education/Training Program | 5666 E State St, Rockford, IL 61108-2425 | 2020-05-22 |
1801415864 | Kyle R Clark | Physician Assistant | 5666 E State St, Rockford, IL 61108-2425 | 2020-04-10 |
1508495144 | Sadie Jae Pierce-mulligan | 5666 E State St, Rockford, IL 61108-2425 | 2020-04-06 | |
1376170183 | Nicole Ann O'neill | Dietitian, Registered | 5666 E State St, Rockford, IL 61108-2425 | 2020-03-24 |
1447884804 | Marissa Ann Giannangeli | Occupational Therapist | 5666 E State St, Rockford, IL 61108-2425 | 2020-02-25 |
1023659711 | Erin R. Moody | Physician Assistant | 5666 E State St, Rockford, IL 61108-2425 | 2019-10-03 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1952862617 | Isr Enterprises, Inc. | Homemaker | 129 Phelps Ave, Bldg 10, Ste 1008, Rockford, IL 61108 | 2019-03-26 |
1003306465 | Adrienne Nicole Black | Behavior Technician | 519 Woodland Dr, Woodland Dr, Rockford, IL 61108 | 2018-05-11 |
1184085201 | Integrative Healing Center, LLC | Clinic/Center | 6019 Fincham Drive, Rockford, IL 61108 | 2016-03-17 |
1730547936 | Perryville Dentist PC | Dentist | 845 S Perryville Rd, Unit 119, Rockford, IL 61108 | 2016-02-02 |
1023489853 | Nicole Ping Ticknor | Counselor | 433 S. Phelps Ave., Suite 2, Rockford, IL 61108 | 2015-10-20 |
1275940348 | Northwest Home Care, Inc. | Home Health | 1437 S. Bell School Road, Suite 7, Rockford, IL 61108 | 2014-07-21 |
1487072922 | Alecia Greenlee | Psychiatry & Neurology | Rosecrance Community Mental Health, 3815 Harrison Avenue, Rockford, IL 61108 | 2014-04-02 |
1871925446 | Maria Laura Gustafson | Interpreter | 3208 Wesleyan Ave., Rockford, IL 61108 | 2013-08-06 |
1346582822 | Joseph Peevey | Pathology | 5666 E State Street, Department of Pathology, Rockford, IL 61108 | 2013-03-21 |
1134466923 | James Henry Peck | Hearing Instrument Specialist | 2424 Charles St, Rockford, IL 61108 | 2013-01-14 |
Find all providers in zip 61108 |
Taxonomy Code | 213E00000X |
Grouping | Podiatric Medicine & Surgery Service Providers |
Classification | Podiatrist |
A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1265895239 | Richard Bell | Podiatrist | 6055 Boxwood Dr, Rockford, IL 61114-6559 | 2016-03-29 |
1801025473 | Nathan Norem | Podiatrist | 2300 N Rockten Ave, Rockford, IL 61103-3619 | 2009-07-05 |
1508967621 | Matthew S. Keene | Podiatrist | 4777 East State Street, Suite 8, Rockford, IL 61108 | 2006-09-25 |
1497854053 | Philip W Seeber | Podiatrist | 3851 N Mulford, Rockford, IL 61114 | 2006-09-21 |
1215042965 | Paul A Galluzzo | Podiatrist | 6999 Redansa Drive, Rockford, IL 61108-1201 | 2006-08-21 |
1497731293 | Thomas A Runne | Podiatrist | 1437 S Bell School Rd Ste 2, Rockford, IL 61108-1405 | 2005-12-22 |
1316507890 | Ashley Ann Smith | Podiatrist | 324 Roxbury Rd, Rockford, IL 61107-5090 | 2019-06-18 |
1184144727 | Donald C Bisby | Podiatrist | 324 Roxbury Rd, Rockford, IL 61107-5090 | 2017-06-25 |
1700239332 | Tiphani James | Podiatrist | 5666 E State St, Rockford, IL 61108-2425 | 2016-07-19 |
1235326455 | Thomas A Runne Dpm Ltd | Podiatrist | 1437 S Bell School Rd Ste 2, Rockford, IL 61108-1405 | 2007-10-02 |
Find all providers in ROCKFORD |
Please comment or provide details below to improve the information on DR. JACOB RUSSELL RANDICH.
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.