DR. RANDI MELLON DDS
NPI 1801200514
Dentist in San Antonio, TX

Q: What is Randi Mellon's NPI number?

The NPI number for Randi Mellon is 1801200514. It was assigned to this individual provider in the NPPES registry on June 20, 2014.

Q: What is Randi Mellon's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Q: Is Randi Mellon enrolled in Medicare?

No. Randi Mellon has opted out of Medicare through May 12, 2028. 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.

Q: When was this NPI record last updated?

The NPPES record for Randi Mellon was last updated on December 19, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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 June 20, 2014Opted out of Medicare · through May 12, 2028

11010 W FM 471 STE 104, SAN ANTONIO, TX 78253(210) 688-9386 Get Directions Write a Review

NPPES record last updated: December 19, 2022. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Dec 19, 2022, Mar 26, 2021, Sep 28, 2019 and 1 more (4 updates tracked since 2019).

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About Dr. Randi Mellon Dds NPPES

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

DR. RANDI MELLON DDS (NPI 1801200514) is an individual dentist in San Antonio, Texas, licensed in Texas (30105) and active in the NPI registry since June 2014. She has opted out of Medicare through May 12, 2028 and remains eligible to order and refer.

NPPES Registry Identity

NPI1801200514

Entity TypeIndividualFemale

Primary Taxonomy122300000X

Provider Legal NameDR. RANDI MELLONCredential: DDS

Location Address11010 W FM 471 STE 104San Antonio, TX 78253-4991

Mailing Address3285 Broad Oak DrBandera, TX 78003-3784 · (361) 537-2634

Phone(210) 688-9386

Sole ProprietorYes

Enumeration DateJune 20, 2014

Last NPPES UpdateDecember 19, 20224 updates tracked since enumeration

NPPES CertifiedDecember 19, 2022

✔ NPI 1801200514 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers

Taxonomy Code122300000X

Licenses✔ Licensed in TX · 30105✔ Licensed in MA · DN1858319

Definition

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

11010 W FM 471 STE 104, San Antonio, TX 78253

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections and more.Insurance ›

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. Randi Mellon Dds 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 May 12, 2016 through May 12, 2028.

Opt-Out Effective DateMay 12, 2016

Opt-Out In Effect ThroughMay 12, 2028Opt-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 78253 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

$84.92 typical visit price

range $54.84 – $166.88

Typical copayment $21.23 (range $13.71 – $41.72)

Most-billed visit code 99203

Established Patient

$68.55 typical visit price

range $17.52 – $136.11

Typical copayment $17.13 (range $4.38 – $34.02)

Most-billed visit code 99213

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 2

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

NATASHA IMPINK-HERNANDEZ DDS

Dentist (General Practice)

11010 W FM 471 STE 104
SAN ANTONIO, TX 78253

Bexar County (210) 688-9386

DR. CHRISTIAN MICHELLE SANCHEZ DDS

Dentist (General Practice)

11010 W FM 471 STE 104
SAN ANTONIO, TX 78253

Bexar County (210) 688-9386

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 Randi Mellon's NPI number?

The NPI number for Randi Mellon is 1801200514. It was assigned to this individual provider in the NPPES registry on June 20, 2014.

Where is Randi Mellon located?

Randi Mellon practices at 11010 W Fm 471 Ste 104, San Antonio, TX 78253. The listed phone number is (210) 688-9386.

What is Randi Mellon's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Is Randi Mellon enrolled in Medicare?

No. Randi Mellon has opted out of Medicare through May 12, 2028. 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.

What insurance does Randi Mellon accept?

Health plans from Ambetter Health, Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections and Ambetter from Superior HealthPlan and 18 other insurers list Randi Mellon 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 Randi Mellon was last updated on December 19, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.