RANDOLPH DIABETES AND WELLNESS LLC
NPI 1609378991
Family Medicine - Adult Medicine in Tampa, FL

Q: What is Randolph Diabetes And Wellness LLC's NPI number?

The NPI number for Randolph Diabetes And Wellness LLC is 1609378991. It was assigned to this organization in the NPPES registry on March 2, 2018.

Q: What is Randolph Diabetes And Wellness LLC's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Adult Medicine, with taxonomy code 207QA0505X.

Active since March 02, 2018CLIA 10D2182314 · Waiver

13047 W LINEBAUGH AVE STE 102, TAMPA, FL 33626(813) 475-6542(813) 475-6874 Get Directions Write a Review

NPPES record last updated: May 12, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: May 12, 2021, Dec 3, 2020, Aug 20, 2019 and 1 more (4 updates tracked since 2018).

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About Randolph Diabetes And Wellness Llc NPPES

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

RANDOLPH DIABETES AND WELLNESS LLC (NPI 1609378991) is a healthcare organization registered as an adult medicine in Tampa, Florida and active in the NPI registry since March 2018. The organization holds a CLIA Waiver certificate valid through April 19, 2028 and lists Kimberly T Randolph, Owner/manager, as its authorized official.

NPPES Registry Identity

NPI1609378991

Entity TypeOrganization

Primary Taxonomy207QA0505X

Legal Business NameRANDOLPH DIABETES AND WELLNESS LLC

Location Address13047 W LINEBAUGH AVE STE 102Tampa, FL 33626-4487

Mailing Address13047 W Linebaugh Ave Ste 102Tampa, FL 33626-4487 · (813) 475-6542 · Fax (813) 475-6874

Phone(813) 475-6542

Fax(813) 475-6874

Organization SubpartNo

Authorized OfficialKimberly T RandolphOwner/manager · (813) 846-7698

Enumeration DateMarch 2, 2018

Last NPPES UpdateMay 12, 20214 updates tracked since enumeration

NPPES CertifiedMay 12, 2021

✔ NPI 1609378991 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyFamily Medicine · Adult MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207QA0505X

Definition

The National Uniform Claim Committee (NUCC) recommends code 207QA0505X not be used. Choose a more appropriate code.

Also ListedClinic/Center · Health ServiceTaxonomy 261QH0100X

Also ListedNurse Practitioner · Adult HealthTaxonomy 363LA2200X · License ARNP9318390 (FL)

13047 W LINEBAUGH AVE STE 102, Tampa, FL 33626

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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Randolph Diabetes And Wellness Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Randolph Diabetes And Wellness LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Kimberly Randolph, ARNP-C

Nurse Practitioner

NPI 1457788671

13047 W LINEBAUGH AVE STE 102
Tampa, FL 33626

(813) 475-6542

✔ PECOS✔ Accepts MedicareSame address

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

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 10D2182314

Randolph Diabetes And Wellness · Tampa, FL

Active · expires Apr 19, 2028

CLIA Number10D2182314

Laboratory TypePhysician Office

Certificate Effective DateApril 20, 2026

Certificate Expiration DateApril 19, 2028

Laboratory DirectorKimberly T. Randolph

Laboratory Phone(813) 475-6542

Laboratory LocationRandolph Diabetes And Wellness13047 W Linebaugh Ave Ste 102, Tampa, FL 33626

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

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 Randolph Diabetes And Wellness LLC's NPI number?

The NPI number for Randolph Diabetes And Wellness LLC is 1609378991. It was assigned to this organization in the NPPES registry on March 2, 2018.

Where is Randolph Diabetes And Wellness LLC located?

Randolph Diabetes And Wellness LLC is located at 13047 W Linebaugh Ave Ste 102, Tampa, FL 33626. The listed phone number is (813) 475-6542.

What is Randolph Diabetes And Wellness LLC's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Adult Medicine, with taxonomy code 207QA0505X.

Is Randolph Diabetes And Wellness LLC enrolled in Medicare?

Yes. Randolph Diabetes And Wellness LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Randolph Diabetes And Wellness LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Randolph Diabetes And Wellness LLC. 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Randolph Diabetes And Wellness LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D2182314) is associated with this NPI, valid through April 19, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Randolph Diabetes And Wellness LLC was last updated on May 12, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.