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AMY RANDOLPH M.ED., CCC-SLP
NPI 1295910057
Speech-Language Pathologist in Bolivia, NC

Active since December 29, 2007
35 REFERENDUM DR NE, BOLIVIA, NC 28422(910) 406-5100 Get Directions Write a Review

NPPES record last updated: March 31, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Amy Randolph M.ed., Ccc-slp NPPES

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

AMY RANDOLPH M.ED., CCC-SLP (NPI 1295910057) is an individual speech-language pathologist provider in Bolivia, North Carolina, licensed in North Carolina (5025) and active in the NPI registry since December 2007.

NPPES Registry Identity

NPI1295910057
Entity TypeIndividualFemale
Primary Taxonomy235Z00000X
Provider Legal NameAMY RANDOLPHCredential: M.ED., CCC-SLP
Location Address35 REFERENDUM DR NEBolivia, NC 28422-7578
Mailing Address4974 Kona Ct Unit 2Southport, NC 28461-7576 · (910) 599-6994 · Fax (704) 274-9212
Phone(910) 406-5100
Sole ProprietorYes
Enumeration DateDecember 29, 2007
Last NPPES UpdateMarch 31, 2026
NPPES CertifiedMarch 31, 2026
✔ NPI 1295910057 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpeech-Language PathologistSpeech, Language and Hearing Service Providers
Taxonomy Code235Z00000X
Licenses✔ Licensed in NC · 5025✔ Licensed in SC · 5639
Definition
The speech-language pathologist is the professional who engages in clinical services, prevention, advocacy, education, administration, and research in the areas of communication and swallowing across the life span from infancy through geriatrics. Speech-language pathologists address typical and atypical impairments and disorders related to communication and swallowing in the areas of speech sound production, resonance, voice, fluency, language (comprehension and expression), cognition, and feeding and swallowing.
35 REFERENDUM DR NE, Bolivia, NC 28422
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Other Identifiers 4

Medicaid7411551NC
Other11945NC · Bcbs Provider #
Other5025NC · Nc License #
Other7211429NC · Medicaid Group Provider #

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Amy Randolph M.ed., Ccc-slp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Billing Reassignments

2

Medicare enrollment records show Amy Randolph reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Legacy Healthcare Services Inc
32 mi
Physical Therapist
190 RIVER PARK DR
Little River, SC 29566
  • Reassigned Medicare billing, South Carolina enrollment
  • 64 clinicians in this Medicare group
NPI 1366063000 (855) 239-3467
Empowerme Rehabilitation, LLC
138 mi
Multi-Specialty
2333 ASHLEY RIVER RD
Charleston, SC 29414
  • Reassigned Medicare billing, South Carolina enrollment
  • 27 clinicians in this Medicare group
NPI 1902476633 (877) 367-9772

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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.

JOURNEE REBEKAH MATTHEWS
Speech-Language Pathologist
35 REFERENDUM DR NE
BOLIVIA, NC 28422
Brunswick County (910) 228-4876
JACLYN J OEHLER MS, CCC-SLP
Speech-Language Pathologist
35 REFERENDUM DR NE
BOLIVIA, NC 28422
Brunswick County (910) 406-5100
RYLEIGH WEBER MS
Speech-Language Pathologist
35 REFERENDUM DR NE
BOLIVIA, NC 28422
Brunswick County (910) 406-5100
MRS. AMANDA MIZELLE M.S.CCC-SLP
Speech-Language Pathologist
35 REFERENDUM DR NE
BOLIVIA, NC 28422
Brunswick County (910) 406-5100
ALISON SLOMBA OTR/L
Occupational Therapist
35 REFERENDUM DR NE
BOLIVIA, NC 28422
Brunswick County (910) 406-5100
ANITA BAKULA SLP
Speech-Language Pathologist
35 REFERENDUM DR NE
BOLIVIA, NC 28422
Brunswick County (910) 406-5100
SELENA ANNE EHLERT OTR/L
Occupational Therapist
35 REFERENDUM DR NE
BOLIVIA, NC 28422
Brunswick County (910) 406-5100
HANNAH LEANN VAUGHN M.A., CCC-SLP
Speech-Language Pathologist
35 REFERENDUM DR NE
BOLIVIA, NC 28422
Brunswick County (910) 406-5100

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 Amy Randolph's NPI number?

The NPI number for Amy Randolph is 1295910057. It was assigned to this individual provider in the NPPES registry on December 29, 2007.

Where is Amy Randolph located?

Amy Randolph practices at 35 Referendum Dr NE, Bolivia, NC 28422. The listed phone number is (910) 406-5100.

What is Amy Randolph's specialty?

The primary specialty registered for this NPI is Speech-Language Pathologist with taxonomy code 235Z00000X.

Is Amy Randolph enrolled in Medicare?

Yes. Amy Randolph is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Amy Randolph's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Amy Randolph reassigns Medicare benefits to 2 organizations: Legacy Healthcare Services Inc (Little River, SC) and Empowerme Rehabilitation, LLC (Charleston, SC). Each 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 Amy Randolph's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Amy Randolph was last updated on March 31, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.