Physician Compare National (NPI:1902856065)

HEALTHCARE PROVIDER: WENDELL LEWIS RANDALL MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1902856065
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6901852664
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20141208001833
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	RANDALL
	Individual professional last name
Provider First Name	WENDELL
	Individual professional first name
Provider Middle Name	L
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	SOUTHERN ILLINOIS UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1985
	Individual professional's medical school graduation year
Primary Specialty	PATHOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	L5 MEDICAL HOLDINGS LLC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	1355594995
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	4
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	8 RADFORD ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 202
	Group Practice or individual's line 2 address
City	CHRISTIANSBURG
	Group Practice or individual's city
State	VA
	Group Practice or individual's state
Zip Code	240733341
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5403812425
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y