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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

DR. RANDOLPH CAREY WALL PH.D.
NPI 1659345163
Psychologist - Clinical in Charlotte, NC

Active since February 14, 2006Opted out of Medicare · through Jan 21, 2027
417 S SHARON AMITY RD, CHARLOTTE, NC 28211(704) 364-0452(704) 364-5481 Get Directions Write a Review

NPPES record last updated: July 13, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dr. Randolph Carey Wall Ph.d. NPPES

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

DR. RANDOLPH CAREY WALL PH.D. (NPI 1659345163) is an individual clinical provider in Charlotte, North Carolina, licensed in North Carolina (1074) and active in the NPI registry since February 2006. He has opted out of Medicare through January 21, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1659345163
Entity TypeIndividualMale
Primary Taxonomy103TC0700X
Provider Legal NameDR. RANDOLPH CAREY WALLCredential: PH.D.
Location Address417 S SHARON AMITY RDCharlotte, NC 28211-2875
Mailing Address417 S Sharon Amity RdCharlotte, NC 28211-2875 · (704) 364-0452 · Fax (704) 364-5481
Phone(704) 364-0452
Fax(704) 364-5481
Sole ProprietorNo
Enumeration DateFebruary 14, 2006
Last NPPES UpdateJuly 13, 2026
✔ NPI 1659345163 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code103TC0700X
License✔ Licensed in NC · 1074
Definition
A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.
417 S SHARON AMITY RD, Charlotte, NC 28211
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Randolph Carey Wall Ph.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 21, 2015 through January 21, 2027.

Opt-Out Effective DateJanuary 21, 2015
Opt-Out In Effect ThroughJanuary 21, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 28211 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
$165.09 typical visit price
range $54.12 – $165.09
Typical copayment $41.27 (range $13.53 – $41.27)
Most-billed visit code 99205
Established Patient
$95.94 typical visit price
range $17.21 – $134.61
Typical copayment $23.98 (range $4.30 – $33.65)
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 3

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

ERIC L. DEITCHMAN PH.D.
Psychologist (Clinical)
417 S SHARON AMITY RD, A
CHARLOTTE, NC 28211
Mecklenburg County (704) 364-0452
DR. JONATHAN WILLIS GOULD PH.D.
Psychologist (Forensic)
417 S SHARON AMITY RD
CHARLOTTE, NC 28211
Mecklenburg County (704) 364-0452
DR. MELINDA SCHUESSLER HARPER PH.D.
Psychologist (Clinical)
417 S SHARON AMITY RD, SUITE A
CHARLOTTE, NC 28211
Mecklenburg County (704) 354-0452

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 Wall's NPI number?

The NPI number for Randolph Wall is 1659345163. It was assigned to this individual provider in the NPPES registry on February 14, 2006.

Where is Randolph Wall located?

Randolph Wall practices at 417 S Sharon Amity Rd, Charlotte, NC 28211. The listed phone number is (704) 364-0452.

What is Randolph Wall's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Randolph Wall enrolled in Medicare?

No. Randolph Wall has opted out of Medicare through January 21, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Randolph Wall was last updated on July 13, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 34 days 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.