DR. KELLY RANDALL (NPI# 1982679171) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982679171 |
| Entity Type | Individual |
| Full Name | DR. KELLY RANDALL |
| Other Name | DR. KELLY RANDALL |
| Credential | M.D. |
| Practice Address |
605 3rd Ave Suite F Fremont OH 43420-3269 |
| Practice Telephone | 4193327311 |
| Practice Fax Number | 4193328552 |
| Mailing Telephone | 4193327311 |
| Mailing Fax Number | 4193328552 |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2013-03-21 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 35-04-5927-R | OH | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | ANTHEM CMIC-FREMONT | 000000350046 | 01 |
| OH | WORKERS' COMP | 341368277-00 | 01 |
| OH | RAILROAD MEDICARE | 200001447 | 01 |
| OH | NEIC | 3413682771923 | 01 |
| OH | 0491052 | 05 | |
| OH | ANTHEM CMIC-TIFFIN | 000000131064 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316487234 | Kelly Ann Randall | Registered Nurse | 15802 N Parkview Pl, Surprise, AZ 85374-7466 | 2017-02-24 |
| 1669719639 | Kelly R Randall | Registered Nurse | 200 W Alona Ln, Lancaster, WI 53813-2202 | 2013-01-11 |
| 1457551285 | Kelly Ross Randall | Occupational Therapist | 324 1st Ave N, George, IA 51237-1029 | 2007-07-19 |
| Street Address |
605 3RD AVE SUITE F |
| City | FREMONT |
| State | OH |
| Zip Code | 43420-3269 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235127606 | James Mckinley Williams | Otolaryngology | 605 3rd Ave, Suite A, Fremont, OH 43420-3269 | 2005-10-11 |
| 1174087803 | Northwest Ohio Orthopedics and Sports Medicine, Inc | Durable Medical Equipment & Medical Supplies | 605 3rd Ave, Fremont, OH 43420-3269 | 2019-01-28 |
| 1306340617 | Jason William Lalone | Nurse Practitioner | 605 3rd Ave, Fremont, OH 43420 | 2018-03-21 |
| 1538546049 | Shelly Ann Lehmann | Nurse Practitioner | 605 3rd Ave, Fremont, OH 43420-3269 | 2015-05-05 |
| 1346529906 | Promedica Ent LLC | Orthopaedic Surgery | 605 3rd Ave, Bldg A Suite A, Fremont, OH 43420-3269 | 2011-08-12 |
| 1831401298 | Kelly Randall Md Inc | Specialist | 605 3rd Ave, Suite F, Fremont, OH 43420-3269 | 2010-07-13 |
| 1427231430 | Primary Care of Northwest Ohio, Inc | Family Medicine | 605 3rd Ave, Blg B Ste D, Fremont, OH 43420-3269 | 2007-12-12 |
| 1891731659 | John M Mauric | Family Medicine | 605 3rd Ave, Suite D, Fremont, OH 43420-3269 | 2006-06-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225596570 | Trisha D Hamm | Nurse Practitioner | Walk In Urgent Care, 2180 Sean Dr., #6b, Fremont, OH 43420 | 2019-03-06 |
| 1558886051 | Kortney Blair Potridge | Homemaker | 1718 Buckland Avenue, Fremont, OH 43420 | 2017-08-07 |
| 1699134015 | Gentle Caring Dentistry of Fremont Ohio | Dentist | 2430 Enterprise St, Fremont, OH 43420 | 2016-02-12 |
| 1033574587 | Alyssa Dickman | Physical Therapy Assistant | 1310 Chestnut St, Fremont, OH 43420 | 2015-12-29 |
| 1437566734 | Michael Allen Koebel | Registered Nurse | 1728 Oak Harbor Rd, Fremont, OH 43420 | 2014-07-18 |
| 1598183774 | Harry D. Burger | Dentist | 567 Bartson Rd., Fremont, OH 43420 | 2014-04-03 |
| 1750706636 | Lori Fisher | Registered Nurse | 500 W. State St., Suite A, Fremont, OH 43420 | 2014-02-28 |
| 1699113001 | Cora Renea Minich | Massage Therapist | 510 Court Street, Fremont, OH 43420 | 2013-06-07 |
| 1477850071 | Parschauer Eye Center Inc | Eyewear Supplier (Equipment, not the service) | 126 S. Front St, Fremont, OH 43420 | 2011-02-16 |
| 1316260839 | Marla D Carlisle | Physician Assistant | 605 Third Avenue, Suite B, Fremont, OH 43420 | 2010-03-11 |
| Find all providers in zip 43420 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225583230 | Peggy Smith | Specialist | 309 Garrison St, Fremont, OH 43420-3031 | 2016-08-19 |
| 1669837894 | Vijayanand Pawar | Specialist | 41238 Roberts Ave, Apt 5, Fremont, CA 94538-4937 | 2015-12-14 |
| 1871864090 | Cheryl Lee Kublin | Specialist | 4554 W. 48th St, Fremont, MI 49412 | 2012-01-19 |
| 1255655213 | Brandy Chipman | Specialist | 140 Lane 587aa Lake James, Fremont, IN 46737-9001 | 2010-03-19 |
| 1396973426 | Aveda Integrative Medical Center Inc | Specialist | 4077 Peralta Blvd, Fremont, CA 94536-4849 | 2009-06-26 |
| 1912142498 | Nancy Kay Corey | Specialist | 40849 Fremont Blvd, Fremont, CA 94538-4306 | 2008-12-11 |
| 1841487337 | Fremont Dermatology Medical Office | Specialist | 39210 State St Ste 218, Fremont, CA 94538-1456 | 2007-09-27 |
| 1922208354 | Anesthesia Professional, PC | Specialist | 708 E 22nd St, Fremont, NE 68025-2657 | 2007-07-24 |
| 1891917316 | Laurie Ann Jirovsky | Specialist | 1915 E 8th St, Fremont, NE 68025-7006 | 2007-05-03 |
| 1437379765 | Deccan Pacific Medical Group | Specialist | 1860 Mowry Ave Ste 400, Fremont, CA 94538-1730 | 2007-04-27 |
| Find all providers in FREMONT | ||||
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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.