Physician Compare National (NPI:1992700520)

HEALTHCARE PROVIDER: WALTER WATSON RANDOLPH III 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	1992700520
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4789783432
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20070621000396
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	RANDOLPH
	Individual professional last name
Provider First Name	WALTER
	Individual professional first name
Provider Middle Name	W
	Individual professional middle name
Provider Name Suffix Text	III
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
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	UNIVERSITY OF TOLEDO COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1995
	Individual professional's medical school graduation year
Primary Specialty	OBSTETRICS/GYNECOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1417 KADERLY ST NW
	Group Practice or individual's line 1 address
City	NEW PHILADELPHIA
	Group Practice or individual's city
State	OH
	Group Practice or individual's state
Zip Code	446631242
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3306025678
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	360010
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	UNION HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	361302
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	TRINITY HOSPITAL TWIN CITY
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y