DERRICK RANDDOLF MD
NPI 1104205343
Family Medicine in Odessa, TX

Q: What is Derrick Randdolf's NPI number?

The NPI number for Derrick Randdolf is 1104205343. It was assigned to this individual provider in the NPPES registry on May 20, 2015.

Q: What is Derrick Randdolf's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Q: When was this NPI record last updated?

The NPPES record for Derrick Randdolf was last updated on February 26, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since May 20, 2015PECOS EnrolledAccepts Medicare Assignment

81.59/100

CMS Quality Rating

701 W 5TH ST, ODESSA, TX 79763(432) 703-5375(432) 703-5238 Get Directions Write a Review

NPPES record last updated: February 26, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Feb 26, 2025, Dec 31, 2024, Jul 13, 2019 (3 updates tracked since 2019).

On this page

About Derrick Randdolf Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DERRICK RANDDOLF MD (NPI 1104205343) is an individual family medicine provider in Odessa, Texas, licensed in Texas (R4622) and active in the NPI registry since May 2015. He is enrolled in Medicare PECOS, is affiliated with Adventhealth Central Texas, and is a graduate of Other (2012).

NPPES Registry Identity

NPI1104205343

Entity TypeIndividualMale

Primary Taxonomy207Q00000X

Provider Legal NameDERRICK RANDDOLFCredential: MD

Location Address701 W 5TH STOdessa, TX 79763-4206

Mailing Address24165 W Interstate 10 Ste 202San Antonio, TX 78257-1160 · (726) 225-2290 · Fax (281) 845-7063

Phone(432) 703-5375

Fax(432) 703-5238

Sole ProprietorNo

Medical School CMSOtherGraduated 2012

Enumeration DateMay 20, 2015

Last NPPES UpdateFebruary 26, 20253 updates tracked since enumeration

NPPES CertifiedFebruary 26, 2025

✔ NPI 1104205343 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

License✔ Licensed in TX · R4622

Definition

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.

Also ListedEmergency MedicineTaxonomy 207P00000X · License R4622 (TX)

701 W 5TH ST, Odessa, TX 79763

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Derrick Randdolf Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8426348178

PECOS Enrollment IDI20171130001563, I20240905001717

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 4

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Emergency department visit with high level of medical decision making 99285

An emergency department visit for severe conditions is when you urgently seek medical help due to serious health issues. These could be severe injuries, breathing problems, unbearable pain, or sudden severe illness. Doctors and nurses will provide immediate care to stabilize your condition.

181 services174 patients

Emergency department visit with moderate level of medical decision making 99284

An emergency department visit for a high-severity issue means you're experiencing a serious health problem that needs immediate attention. This could be a severe injury, serious illness, or life-threatening condition. Medical professionals will provide urgent care to stabilize your condition.

169 services162 patients

Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only 93010

A routine electrocardiogram (ECG) with 12 leads is a simple, non-invasive test that records the electrical activity of your heart. It helps in identifying heart conditions by detecting irregularities in your heart rhythms. The results are interpreted and a report is provided.

44 services43 patients

Emergency department visit with low level of medical decision making 99283

An emergency department visit for a problem of moderate severity involves immediate medical attention for issues like minor fractures, burns, or high fever. The healthcare team will assess your condition, provide necessary treatment, and may suggest further tests or admission if required.

15 services15 patients

Hospital Affiliations CMS Care Compare 4

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Adventhealth Central Texas

Acute Care Hospitals · Killeen, TX

4/5 CMS rating

OwnershipVoluntary non-profit - Church

CMS Certification Number450152

Location2201 S Clear Creek RoadKilleen, TX 76542 · Bell County

Emergency services Birthing friendly

Hill Country Memorial Hospital

Acute Care Hospitals · Fredericksburg, TX

5/5 CMS rating

OwnershipProprietary

CMS Certification Number450604

Location1020 South State Highway 16Fredericksburg, TX 78624 · Gillespie County

Emergency services Birthing friendly

Scenic Mountain Medical Center, A Steward Family H

Acute Care Hospitals · Big Spring, TX

OwnershipProprietary

CMS Certification Number450653

Location1601 W 11th PlaceBig Spring, TX 79720 · Howard County

Emergency services Birthing friendly

Baptist Neighborhood Hospital Thousand Oaks

Acute Care Hospitals · San Antonio, TX

4/5 CMS rating

OwnershipProprietary

CMS Certification Number670078

Location16088 San PedroSan Antonio, TX 78232 · Bexar County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 79763 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$84.92 typical visit price

range $54.84 – $166.88

Typical copayment $21.23 (range $13.71 – $41.72)

Most-billed visit code 99203

Established Patient

$97.05 typical visit price

range $17.52 – $136.11

Typical copayment $24.26 (range $4.38 – $34.02)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

81.59/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored as part of a group practice

Quality

69.53

Improvement Activities

Referred Medical Equipment & Supplies CMS DME claims 2

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing E0431

DME-Oxygen and Supplies · category DC000N

1 supplier19 claims19 services$19.07 avg. paid by Medicare

Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate E1390

DME-Oxygen and Supplies · category DC002N

2 suppliers28 claims28 services$109.46 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ADETOMIWA OGUNDERE M.D.

Internal Medicine

701 W 5TH ST
ODESSA, TX 79763

Ector County (432) 703-5375

DR. CARLOS NIETO JR. M.D.

Pediatrics (Pediatric Critical Care Medicine)

701 W 5TH ST
ODESSA, TX 79763

Ector County (432) 335-1500

AMOGE CHINENYE OPARA MD

Student in an Organized Health Care Education/Training Program

701 W 5TH ST
ODESSA, TX 79763

Ector County (432) 703-5238

DR. STEPHANIE VILLARREAL M.D.

Pediatrics

701 W 5TH ST
ODESSA, TX 79763

Ector County (432) 335-2222

MERIDITH LYNN BUZBEE

Student in an Organized Health Care Education/Training Program

701 W 5TH ST
ODESSA, TX 79763

Ector County (432) 703-5083

CARINA ROSE GOODART

Student in an Organized Health Care Education/Training Program

701 W 5TH ST
ODESSA, TX 79763

Ector County (432) 703-5238

CHUKWUDIKE GREAT NNAJI

Student in an Organized Health Care Education/Training Program

701 W 5TH ST
ODESSA, TX 79763

Ector County (432) 703-5238

LUTFOR NESSA MD, MPH

Internal Medicine

701 W 5TH ST
ODESSA, TX 79763

Ector County (432) 703-5375

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Derrick Randdolf's NPI number?

The NPI number for Derrick Randdolf is 1104205343. It was assigned to this individual provider in the NPPES registry on May 20, 2015.

Where is Derrick Randdolf located?

Derrick Randdolf practices at 701 W 5th St, Odessa, TX 79763. The listed phone number is (432) 703-5375.

What is Derrick Randdolf's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Derrick Randdolf enrolled in Medicare?

Yes. Derrick Randdolf is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Derrick Randdolf accept?

Health plans from Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Superior HealthPlan and Ambetter of Oklahoma and 6 other insurers list Derrick Randdolf as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Derrick Randdolf affiliated with any hospitals?

According to CMS data, Derrick Randdolf is affiliated with Adventhealth Central Texas, Hill Country Memorial Hospital, Scenic Mountain Medical Center, A Steward Family H and Baptist Neighborhood Hospital Thousand Oaks.

When was this NPI record last updated?

The NPPES record for Derrick Randdolf was last updated on February 26, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.