Dr Mary Kay Randolph, MD is a medicare enrolled "Family Medicine" physician in Polo, Missouri. Her current practice location is
36584 W 220th St, Polo, Missouri. You can reach out to her office (for appointments etc.) via phone at
(816) 809-7730.
Dr Mary Kay Randolph is licensed to practice in Missouri (license number 101542) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1841203023.
Physician's Profile
| Full Name | Dr Mary Kay Randolph |
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| Gender | Female |
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| Speciality | Family Medicine |
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| Location | 36584 W 220th St, Polo, Missouri |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1841203023
- Provider Enumeration Date: 08/15/2006
- Last Update Date: 09/19/2023
Medicare PECOS Information:
- PECOS PAC ID: 4385714534
- Enrollment ID: I20130121000094
Medical Identifiers
Medical identifiers for Dr Mary Kay Randolph such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1841203023 | NPI | - | NPPES |
| 068002402 | Other | KS | MEDICARE PTAN |
| 100175570C | Medicaid | KS | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207Q00000X | Family Medicine | 036-121726 (Illinois) | Secondary |
| 207Q00000X | Family Medicine | 04-25049 (Kansas) | Secondary |
| 207Q00000X | Family Medicine | 101542 (Missouri) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Mary Kay Randolph allows following entities to bill medicare on her behalf.
| Entity Name | Midwest Division - Lrhc Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1639362460
PECOS PAC ID: 0941119150
Enrollment ID: O20031105000738 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Mary Kay Randolph is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Mary Kay Randolph, MD
36584 W 220th St,
Polo, MO 64671-8669
Ph: (816) 809-7730 | Dr Mary Kay Randolph, MD
36584 W 220th St,
Polo, MO 64671-8669
Ph: (816) 809-7730 |
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