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DR. JOHN RANDOLPH M.D.
NPI 1689677882
Family Medicine in Liberty, SC

Active since May 23, 2005PECOS EnrolledAccepts Medicare Assignment
105 LIBERTY BLVD, LIBERTY, SC 29657(864) 843-8500(864) 843-5634 Get Directions Write a Review

NPPES record last updated: October 14, 2014. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Dr. John Randolph M.d. NPPES

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

DR. JOHN RANDOLPH M.D. (NPI 1689677882) is an individual family medicine provider in Liberty, South Carolina, licensed in South Carolina (24613) and active in the NPI registry since May 2005. He is enrolled in Medicare PECOS, is affiliated with Cannon Memorial Hospital, and is a graduate of Ohio State University College Of Medicine (1998).

NPPES Registry Identity

NPI1689677882
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameDR. JOHN RANDOLPHCredential: M.D.
Location Address105 LIBERTY BLVDLiberty, SC 29657-1641
Mailing AddressPo Box 919Pickens, SC 29671-0919 · (864) 897-8277 · Fax (864) 878-0035
Phone(864) 843-8500
Fax(864) 843-5634
Sole ProprietorNo
Medical School CMSOhio State University College Of MedicineGraduated 1998
Enumeration DateMay 23, 2005
Last NPPES UpdateOctober 14, 2014
✔ NPI 1689677882 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Licenses✔ Licensed in SC · 24613✔ Licensed in OH · 35074072
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
105 LIBERTY BLVD, Liberty, SC 29657
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Other Identifiers 3

Medicare UPING94103OH
Medicaid2141300OH
Medicare ID-Type UnspecifiedRA0877661OH

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter Health, Ambetter of North Carolina 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

Dr. John Randolph M.d. 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 ID2062557622
PECOS Enrollment IDI20141226000079
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

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

Cannon Memorial Hospital
Same address
Family Medicine
105 LIBERTY BLVD
Liberty, SC 29657
  • Reassigned Medicare billing, South Carolina enrollment
  • Also billed through NPI 1245930064 (South Carolina)
  • 11 clinicians in this Medicare group
NPI 1750304135 (864) 843-9213

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 3

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

Cannon Memorial Hospital

Acute Care Hospitals · Pickens, SC
OwnershipVoluntary non-profit - Private
CMS Certification Number420011
Location123 W G Acker DrivePickens, SC 29671 · Pickens County
Emergency services

Anmed Health

Acute Care Hospitals · Anderson, SC
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number420027
Location800 N Fant StAnderson, SC 29621 · Anderson County
Emergency services Birthing friendly

Prisma Health Greenville Memorial Hospital

Acute Care Hospitals · Greenville, SC
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number420078
Location701 Grove RoadGreenville, SC 29605 · Greenville County
Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 29657 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
$83.18 typical visit price
range $53.57 – $163.84
Typical copayment $20.79 (range $13.39 – $40.96)
Most-billed visit code 99203
Established Patient
$95.12 typical visit price
range $16.96 – $133.52
Typical copayment $23.78 (range $4.24 – $33.38)
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.

Referred Medical Equipment & Supplies CMS DME claims 2

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
8 suppliers23 claims59 services$6.29 avg. paid by Medicare
Lancets, per box of 100 A4259
DME-Medical/Surgical Supplies · category DA000N
6 suppliers12 claims16 services$1.06 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 4

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

AUGUSTA B HALL FNP - C
Nurse Practitioner (Family)
105 LIBERTY BLVD
LIBERTY, SC 29657
Pickens County (864) 843-9213
CANNON MEMORIAL HOSPITAL
Family Medicine
105 LIBERTY BLVD
LIBERTY, SC 29657
Pickens County (864) 843-9213
CANNON MEMORIAL HOSPITAL
Clinic/Center (Rural Health)
105 LIBERTY BLVD
LIBERTY, SC 29657
Pickens County (864) 843-9213
ANMED HEALTH
Obstetrics & Gynecology
105 LIBERTY BLVD
LIBERTY, SC 29657
Pickens County (800) 825-6688

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 John Randolph's NPI number?

The NPI number for John Randolph is 1689677882. It was assigned to this individual provider in the NPPES registry on May 23, 2005.

Where is John Randolph located?

John Randolph practices at 105 Liberty Blvd, Liberty, SC 29657. The listed phone number is (864) 843-8500.

What is John Randolph's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is John Randolph enrolled in Medicare?

Yes. John Randolph is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for John Randolph's services?

According to the CMS Revalidation Reassignment List (October 2026 release), John Randolph reassigns Medicare benefits to Cannon Memorial Hospital (Liberty, SC). The 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 John Randolph's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does John Randolph accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of North Carolina, BlueCross BlueShield of South Carolina and First Choice Next and 1 other insurer list John Randolph 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.

Is John Randolph affiliated with any hospitals?

According to CMS data, John Randolph is affiliated with Cannon Memorial Hospital, Anmed Health and Prisma Health Greenville Memorial Hospital.

When was this NPI record last updated?

The NPPES record for John Randolph was last updated on October 14, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.