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CLEVELAND W RANDOLPH, JR, MD, PA
NPI 1497808182
Specialist in Jacksonville Beach, FL

Active since January 18, 2007
1891 BEACH BLVD STE 200, JACKSONVILLE BEACH, FL 32250(904) 249-3743(904) 249-2047 Get Directions Write a Review

NPPES record last updated: December 1, 2025. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Dec 1, 2025, Nov 5, 2025 (2 updates tracked since 2025).

About Cleveland W Randolph, Jr, Md, Pa NPPES

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

CLEVELAND W RANDOLPH, JR, MD, PA (NPI 1497808182), doing business as Dr. Randolph's Ageless & Wellness Medical Center, is a healthcare organization registered as a specialist in Jacksonville Beach, Florida and active in the NPI registry since January 2007. The organization lists Victoria Louise Galler, Practice Administrator, as its authorized official.

NPPES Registry Identity

NPI1497808182
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameCLEVELAND W RANDOLPH, JR, MD, PA
Location Address1891 BEACH BLVD STE 200Jacksonville Beach, FL 32250-2644
Mailing Address1891 Beach Blvd Ste 200Jacksonville Beach, FL 32250-2644 · (904) 249-3743 · Fax (904) 249-2047
Phone(904) 249-3743
Fax(904) 249-2047
Organization SubpartNo
Authorized OfficialVictoria Louise GallerPractice Administrator · (904) 249-3743
Enumeration DateJanuary 18, 2007
Last NPPES UpdateDecember 1, 20252 updates tracked since enumeration
NPPES CertifiedDecember 1, 2025
✔ NPI 1497808182 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in FL · ME0042493
Definition
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.
1891 BEACH BLVD STE 200, Jacksonville Beach, FL 32250
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Other Names 1

Doing Business AsDr. Randolph's Ageless & Wellness Medical Center

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include AvMed, Florida Blue (BlueCross BlueShield FL), Florida Blue HMO (a BlueCross BlueShield FL company).Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Cleveland W Randolph, Jr, Md, Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

8

Medicare enrollment records show 8 clinicians reassign Medicare billing to Cleveland W Randolph, Jr, MD, PA, which bills Medicare for the services they deliver. Of these, 6 practice at this address. They are listed nearest first.

Clinicians, nearest first (8)

Esteban Garces, APRN
Nurse Practitioner
NPI 1295176998
1891 BEACH BLVD SUITE 200
Jacksonville Beach, FL 32250
(904) 249-3743
✔ PECOS✔ Accepts MedicareSame address
Sherri Jackson, APRN
Nurse Practitioner
NPI 1144657263
1891 BEACH BLVD
Jacksonville Beach, FL 32250
(904) 249-3743
✔ PECOS✔ Accepts MedicareSame address
Donny Klay, APRN
Nurse Practitioner
NPI 1093183444
1891 BEACH BLVD
Jacksonville Beach, FL 32250
(904) 249-3743
✔ PECOS✔ Accepts MedicareSame address
Nicole Thomas, APRN
Nurse Practitioner
NPI 1003065509
1891 BEACH BLVD SUITE 200
Jacksonville Beach, FL 32250
(904) 249-3743
✔ PECOS✔ Accepts MedicareSame address
Lori Leaseburge, MD
Obstetrics/Gynecology
NPI 1275628455
1891 BEACH BLVD SUITE 200
Jacksonville, FL 32250
(904) 249-3743
✔ PECOS✔ Accepts MedicareSame address
Cleveland Randolph, M.D.
Obstetrics/Gynecology
NPI 1124014287
1891 BEACH BLVD STE. 200
Jacksonville Beach, FL 32250
(904) 249-3743
✔ PECOS✔ Accepts MedicareSame address
Anthony Premo, APRN, AGACNP-BC
Nurse Practitioner
NPI 1033840806
14785 OLD SAINT AUGUSTINE RD STE 100
Jacksonville, FL 32258
(904) 456-0017
✔ PECOS✔ Accepts Medicare12 mi
Malissa Richter, APRN
Nurse Practitioner
NPI 1609407428
5978 POWERS AVE
Jacksonville, FL 32217
(904) 339-2525
✔ PECOS✔ Accepts Medicare13 mi

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

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 Cleveland W Randolph, Jr, MD, PA's NPI number?

The NPI number for Cleveland W Randolph, Jr, MD, PA is 1497808182. It was assigned to this organization in the NPPES registry on January 18, 2007. The provider is doing business as Dr. Randolph's Ageless & Wellness Medical Center.

Where is Cleveland W Randolph, Jr, MD, PA located?

Cleveland W Randolph, Jr, MD, PA is located at 1891 Beach Blvd Ste 200, Jacksonville Beach, FL 32250. The listed phone number is (904) 249-3743.

What is Cleveland W Randolph, Jr, MD, PA's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is Cleveland W Randolph, Jr, MD, PA enrolled in Medicare?

Yes. Cleveland W Randolph, Jr, MD, PA is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Cleveland W Randolph, Jr, MD, PA?

According to the CMS Revalidation Reassignment List (October 2026 release), 8 clinicians in 2 Medicare specialties reassign their Medicare billing to Cleveland W Randolph, Jr, MD, PA. 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 (6) and Obstetrics/Gynecology (2). Of these, 6 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Cleveland W Randolph, Jr, MD, PA accept?

Health plans from AvMed, Florida Blue (BlueCross BlueShield FL) and Florida Blue HMO (a BlueCross BlueShield FL company) list Cleveland W Randolph, Jr, MD, PA 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 Cleveland W Randolph, Jr, MD, PA was last updated on December 1, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.