RANDALL DERMATOLOGY, PC
NPI 1245340488
Dermatology in West Lafayette Bra, IN
About Randall Dermatology, Pc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
RANDALL DERMATOLOGY, PC (NPI 1245340488) is a healthcare organization registered as a dermatology in West Lafayette Bra, Indiana and active in the NPI registry since August 2006. The organization holds 5 active CLIA laboratory certificates and lists John K Randall, President/owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 4
Other Identifiers 1
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Randall Dermatology, Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by February 28, 2027
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
11Medicare enrollment records show 11 clinicians reassign Medicare billing to Randall Dermatology, PC, which bills Medicare for the services they deliver. Of these, 11 practice at this address. They are listed nearest first.
Clinicians by Medicare Specialty 2
Clinicians, nearest first (11)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA 5
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 15D2143506
Randall Dermatology, PC · Rensselaer, INCertificate of Waiver 15D2143507
Randall Dermatology, PC · Westfield, INCertificate of Waiver 15D2143508
Randall Dermatology, PC · Terre Haute, INCertificate of Compliance 15D1037471
Randall Dermatology PC · Kokomo, INCertificate of Compliance 15D0910366
Randall Dermatology, PC · West Lafayette, INFrequently 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 Randall Dermatology, PC's NPI number?
The NPI number for Randall Dermatology, PC is 1245340488. It was assigned to this organization in the NPPES registry on August 30, 2006.
Where is Randall Dermatology, PC located?
Randall Dermatology, PC is located at 124 Sagamore Pkwy W, West Lafayette Bra, IN 47906. The listed phone number is (765) 463-6722.
What is Randall Dermatology, PC's specialty?
The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.
Is Randall Dermatology, PC enrolled in Medicare?
Yes. Randall Dermatology, PC is registered in the Medicare PECOS enrollment system.
When is Randall Dermatology, PC's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Indiana, Clinic/Group Practice) is due for revalidation by February 28, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Randall Dermatology, PC?
According to the CMS Revalidation Reassignment List (October 2026 release), 11 clinicians in 2 Medicare specialties reassign their Medicare billing to Randall Dermatology, PC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (10) and Micrographic Dermatologic Surgery (MDS) (1). Of these, 11 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Randall Dermatology, PC hold CLIA laboratory certificates?
Yes. 5 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.
What insurance does Randall Dermatology, PC accept?
Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Anthem Blue Cross and Blue Shield and CareSource list Randall Dermatology, PC 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.
When was this NPI record last updated?
The NPPES record for Randall Dermatology, PC was last updated on December 19, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 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.
# Randall Dermatology, Pc · NPI 1245340488
Dermatology organization in West Lafayette Bra, Indiana. Organization record, active in the CMS NPPES registry since August 30, 2006.
## Identity
- **NPI:** 1245340488 (Entity type: Organization)
- **Enumerated:** August 30, 2006
- **Primary specialty:** Dermatology · taxonomy 207N00000X
- **Organization subpart:** No
- **Authorized official:** John Randall, PRESIDENT/OWNER
## Practice location
- **Address:** 124 SAGAMORE PKWY W, West Lafayette Bra, IN 47906-1569
- **Phone:** (765) 463-6722 · **Fax:** (765) 463-0905
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** February 28, 2027 (Non-DME Part B, Indiana, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 11 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (10), Micrographic Dermatologic Surgery (MDS) (1); 11 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** December 19, 2024
- **Other identifiers:** Medicaid 200207110A (IN)
- **CLIA laboratory certificates:** 5 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1245340488) · Data from the CMS NPPES public registry.