JENNIFER RANDALL RD
NPI 1558138552
Dietitian, Registered in Portland, OR

Q: What is Jennifer Randall's NPI number?

The NPI number for Jennifer Randall is 1558138552. It was assigned to this individual provider in the NPPES registry on December 8, 2023.

Q: What is Jennifer Randall's specialty?

The primary specialty registered for this NPI is Dietitian, Registered with taxonomy code 133V00000X.

Q: When was this NPI record last updated?

The NPPES record for Jennifer Randall was last updated on January 11, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years 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 December 08, 2023Accepts Medicare Assignment

1040 NW 22ND AVE STE 520, PORTLAND, OR 97210(503) 413-7557 Get Directions Write a Review

NPPES record last updated: January 11, 2024. Verified against the NPPES registry weekly; last sync: November 01, 2026.

On this page

About Jennifer Randall Rd NPPES

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

JENNIFER RANDALL RD (NPI 1558138552) is an individual dietitian, registered in Portland, Oregon, licensed in Oregon (LD-D-10238407) and active in the NPI registry since December 2023. She is affiliated with Legacy Good Samaritan Medical Center and is a graduate of Other (2022).

NPPES Registry Identity

NPI1558138552

Entity TypeIndividualFemale

Primary Taxonomy133V00000X

Provider Legal NameJENNIFER RANDALLCredential: RD

Location Address1040 NW 22ND AVE STE 520Portland, OR 97210-3097

Mailing Address612 Nw 20th Ave Apt 17Portland, OR 97209-1223 · (925) 286-2298

Phone(503) 413-7557

Sole ProprietorNo

Medical School CMSOtherGraduated 2022

Enumeration DateDecember 8, 2023

Last NPPES UpdateJanuary 11, 2024

NPPES CertifiedJanuary 11, 2024

✔ NPI 1558138552 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDietitian, RegisteredDietary & Nutritional Service Providers

Taxonomy Code133V00000X

License✔ Licensed in OR · LD-D-10238407

Definition

A Registered Dietitian (RD)/Registered Dietitian Nutritionist (RDN) is an individual uniquely trained in the science of nutrition and practice of dietetics to design and provide medical nutrition therapy (MNT) and other evidence-based applications of the Nutrition Care Process (NCP) that exemplify the profession's systematic approach to providing high quality nutrition care. Registered dietitians provide MNT for the purpose of disease prevention or management, or to treat or rehabilitate an illness, injury, or condition, with the use of specific, indicated physical and cognitive nutrition care services comprised of one or more of the following aspects of the NCP: nutrition assessment/reassessment, nutrition diagnosis, nutrition intervention (e.g., nutrition counseling, therapeutic diet ordering, and nutrition education) and nutrition monitoring and evaluation.

1040 NW 22ND AVE STE 520, Portland, OR 97210

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Moda Health Plan, Inc., PacificSource Health Plans and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jennifer Randall Rd 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 ID143673293

PECOS Enrollment IDI20240125001472

Medicare Billing Reassignment

Medicare enrollment records show Jennifer Randall reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Legacy Good Samaritan Hospital And Medical Center

0.1 mi

General Acute Care Hospital

1015 NW 22ND AVE
Portland, OR 97210

Reassigned Medicare billing, Oregon enrollment
387 clinicians in this Medicare group

NPI 1780608216 (503) 413-7711

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

Hospital Affiliations CMS Care Compare

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

Legacy Good Samaritan Medical Center

Acute Care Hospitals · Portland, OR

5/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number380017

Location1015 NW 22nd Avenue, W121Portland, OR 97210 · Multnomah County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 97210 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

$0.00 typical visit price

range $58.99 – $176.88

Typical copayment $0.00 (range $14.74 – $44.22)

Most-billed visit code NA

Established Patient

$103.51 typical visit price

range $19.32 – $144.79

Typical copayment $25.87 (range $4.83 – $36.19)

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.

Other Providers at the Same Location NPPES 12

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

RYAN FAIRLEY

Surgery