1. Home
  2. Directory
  3. Missouri
  4. Saint Louis
  5. Dietitian Registered
  6. NPI Profile

MRS. BETHANY N RANDOLPH
NPI 1730904251
Dietitian, Registered in Saint Louis, MO

Active since November 19, 2024
615 S BALLAS RD, SAINT LOUIS, MO 63122(314) 251-5550 Get Directions Write a Review

NPPES record last updated: November 19, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Mrs. Bethany N Randolph NPPES

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

MRS. BETHANY N RANDOLPH (NPI 1730904251) is an individual dietitian, registered in Saint Louis, Missouri, licensed in Missouri (2001015394) and active in the NPI registry since November 2024.

NPPES Registry Identity

NPI1730904251
Entity TypeIndividualFemale
Primary Taxonomy133V00000X
Provider Legal NameMRS. BETHANY N RANDOLPH
Location Address615 S BALLAS RDSaint Louis, MO 63122-5314
Mailing Address615 S Ballas RdSaint Louis, MO 63122-5314 · (314) 251-5550
Phone(314) 251-5550
Sole ProprietorYes
Enumeration DateNovember 19, 2024
NPPES CertifiedNovember 19, 2024
✔ NPI 1730904251 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 MO · 2001015394
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.
615 S BALLAS RD, Saint Louis, MO 63122
Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Sunflower Health Plan, Ambetter Health 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 (PECOS)

Mrs. Bethany N Randolph is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Billing Reassignment

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

Mercy Clinic Kids Gi, LLC
6.5 mi
Pediatric Gastroenterology
621 S NEW BALLAS RD, SUITE 140-A
Saint Louis, MO 63141
  • Reassigned Medicare billing, Missouri enrollment
  • 9 clinicians in this Medicare group
NPI 1033352885 (314) 996-0006

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

Other Providers at the Same Location NPPES 6

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

DR. AMJAD TAHA M.D.
Pediatrics (Neonatal-Perinatal Medicine)
615 S BALLAS RD
SAINT LOUIS, MO 63122
St. Louis County (602) 346-7054
MS. TAMMY CAROL LENTZ RNC, MSN, NNP-BC
Nurse Practitioner (Neonatal)
615 S BALLAS RD
SAINT LOUIS, MO 63122
St. Louis County (314) 251-6000
MR. WARREN GAYLE JONES R.PH.
Pharmacist (Critical Care)
615 S BALLAS RD
SAINT LOUIS, MO 63122
St. Louis County (314) 251-6046
DR. TIMOTHY BUCCI M.D.
Internal Medicine
615 S BALLAS RD
SAINT LOUIS, MO 63122
St. Louis County (314) 251-5834
REBECCA HRUSKA CSFA
Physician Assistant (Surgical)
615 S BALLAS RD
SAINT LOUIS, MO 63122
St. Louis County (618) 616-1658
CHRISTOPHER HAUSE ACNP
Nurse Practitioner (Adult Health)
615 S BALLAS RD
SAINT LOUIS, MO 63122
St. Louis County (636) 358-9204

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 Bethany Randolph's NPI number?

The NPI number for Bethany Randolph is 1730904251. It was assigned to this individual provider in the NPPES registry on November 19, 2024.

Where is Bethany Randolph located?

Bethany Randolph practices at 615 S Ballas Rd, Saint Louis, MO 63122. The listed phone number is (314) 251-5550.

What is Bethany Randolph's specialty?

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

Is Bethany Randolph enrolled in Medicare?

Yes. Bethany Randolph is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Bethany Randolph's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Bethany Randolph reassigns Medicare benefits to Mercy Clinic Kids Gi, LLC (Saint Louis, MO). 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 Bethany Randolph's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Bethany Randolph accept?

Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Arkansas Health & Wellness, Ambetter from Sunflower Health Plan and Ambetter of Oklahoma and 2 other insurers list Bethany 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.

When was this NPI record last updated?

The NPPES record for Bethany Randolph was last updated on November 19, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 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.