Dr Mary Kay Randolph, MD - Medicare Family Medicine in Polo, MO

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.

Contact Information

Dr Mary Kay Randolph, MD
36584 W 220th St,
Polo, MO 64671-8669
(816) 809-7730
Not Available



Physician's Profile

Full NameDr Mary Kay Randolph
GenderFemale
SpecialityFamily Medicine
Location36584 W 220th St, Polo, Missouri
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  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.
IdentifierTypeStateIssuer
1841203023NPI-NPPES
068002402OtherKSMEDICARE PTAN
100175570CMedicaidKS

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
207Q00000XFamily Medicine 036-121726 (Illinois)Secondary
207Q00000XFamily Medicine 04-25049 (Kansas)Secondary
207Q00000XFamily 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 NameMidwest Division - Lrhc Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI 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 AddressPractice 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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Family Medicine Doctors in Polo, MO


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