{
"Npi": {
"NPI": "1487441069",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "RANDOLPH",
"FirstName": "MADELEINE",
"MiddleName": "KATHRYN",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "MD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "LAFOND",
"OtherFirstName": "MADELEINE",
"OtherMiddleName": "KATHYRN",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "1555 NORTHWAY DR STE 200",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAINT CLOUD",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "56303-4913",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "320-240-3157",
"MailingAddressFaxNumber": "320-240-3165",
"FirstLinePracticeLocationAddress": "1555 NORTHWAY DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAINT CLOUD",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "56303-4555",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "320-240-3157",
"PracticeLocationAddressFaxNumber": "320-240-3165",
"EnumerationDate": "04/24/2025",
"LastUpdateDate": "04/24/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "390200000X",
"TaxonomyName": "Student in an Organized Health Care Education/Training Program",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}