GANNON B RANDOLPH M.D.
NPI 1528173697
Orthopaedic Surgery - Orthopaedic Surgery of the Spine in Bentonville, AR

NPI Status: Active since August 20, 2006

Contact Information

1800 SE MOBERLY LN
BENTONVILLE, AR
ZIP 72712
Phone: (479) 521-2752
Fax: (479) 521-4603

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  • Individual
  • Male
  • Years of Experience 26
  • Orthopaedic Surgery
  • Orthopaedic Surgery of the Spine
  • Accepts Insurance
  • Accepts Medicare Approved Payment
  • PECOS Enrolled

About GANNON RANDOLPH

This page provides the complete NPI Profile along with additional information for Gannon Randolph, a provider established in Bentonville, Arkansas with a medical specialization in Orthopaedic Surgery, focusing in orthopaedic surgery of the spine and more than 26 years of experience. He graduated from Oregon Health Sciences University School Of Medicine in 2000. The healthcare provider is registered in the NPI registry with number 1528173697 assigned on August 2006. The practitioner's primary taxonomy code is 207XS0117X with license number E5957 (AR). The provider is registered as an individual and his NPI record was last updated 4 years ago.

NPI
1528173697
Provider Name
GANNON B RANDOLPH M.D.
Gender
Male
Entity Type
Individual
Location Address
1800 SE MOBERLY LN BENTONVILLE, AR 72712
Location Phone
(479) 521-2752
Location Fax
(479) 521-4603
Mailing Address
3317 N WIMBERLY DR FAYETTEVILLE, AR 72703
Mailing Phone
(479) 521-2752
Mailing Fax
(479) 521-4603
Medical School Name
OREGON HEALTH SCIENCES UNIVERSITY SCHOOL OF MEDICINE
Graduation Year
2000
Is Sole Proprietor?
No
Enumeration Date
08-20-2006
Last Update Date
07-12-2021
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Location Map

Secondary Locations

  • 1101 S Horsebarn Rd
    Rogers, AR 72758
    (479) 271-9607

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Orthopaedic Surgery Orthopaedic Surgery of the Spine

Taxonomy Code
207XS0117X
Type
Allopathic & Osteopathic Physicians
License No.
E5957
License State
AR
Taxonomy Description
Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, orthopaedic surgeons of the spine deal with the evaluation and nonoperative and operative treatment of the full spectrum of primary spinal disorders including trauma, degenerative, deformity, tumor, and reconstructive.

Secondary Taxonomies

The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.

No. Taxonomy Code Type Classification /
Specialization
License No. (State)
1207X00000XAllopathic & Osteopathic Physicians

Orthopaedic Surgery

E5957 (AR)

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

  • Bronze Exp Standardized - PPO
  • Bronze Value - PPO
  • Gold Standardized - PPO
  • Silver AH - PPO
  • Silver Standardized - PPO
  • Silver Value - PPO
  • Dental Gold - PPO
  • Dental Gold Plus Vision - PPO
  • Dental Pediatric - PPO
  • Dental Platinum - PPO
  • HA Bronze Exp Standardized - POS
  • HA Bronze Suitcase - POS
  • HA Gold Standardized - POS
  • HA Silver AH - POS
  • HA Silver Premier Suitcase - POS
  • HA Silver Standardized - POS
  • Octave Bronze Exp Standardized - POS
  • Octave Bronze Value - POS
  • Octave Gold Standardized - POS
  • Octave Silver AH - POS
  • Octave Silver Classic Suitcase - POS
  • Octave Silver Standardized - POS
  • Essential Bronze 6500 - POS
  • Essential Gold 1500 - POS
  • Freedom Silver 4000 - POS
  • Savings Bronze 7700 - POS
  • Standard Bronze 7500 - POS
  • Standard Gold 1500 - POS
  • Standard Silver 5000 - POS

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State Identifier Issuer
1176259001MEDICAID (05)AR 

Medicare Participation & PECOS Enrollment Status

Gannon Randolph is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.

Gannon Randolph is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

  • Is the provider registered in PECOS? Yes

  • PECOS PAC ID: 941230619

    What is the PECOS Associate Control ID?
    A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.

  • PECOS Enrollment ID: I20090327000295

    What is the Provider Enrollment ID?
    The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.

  • Accepts Medicare Assignment? Yes

    What does it mean "accepts medicare assignment"?
    When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
    A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.

  • Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes

  • Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes

  • Eligible to Order or Refer a Home Health Agency (HHA): Yes

  • Eligible to Order or Refer Power Mobility Devices: Yes

Provider Referred Orders for Durable Medical Equipment, Devices & Supplies

The following list reflects the services, supplies or durable medical equipment ordered by this provider to a DME supplier on behalf of patients. The information below is derived from Medicare claims data and reflects the BETOS category, HCPCS code information and the number times each service was submitted under the Medicare fee-for-service program.

Durable Medical Equipment

  • DME-Other DME (DE000N)

    Osteogenesis stimulator, electrical, non-invasive, spinal applications (HCPCS:E0748)

    1 DME suppliers used 18 Medicare Claims 18 Services Paid

Orthotic Devices

  • DME-Orthotic Devices (DF000N)

    Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension, prefabricated, off-the-shelf (HCPCS:L0174)

    2 DME suppliers used 13 Medicare Claims 13 Services Paid

  • DME-Orthotic Devices (DF007N)

    Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf (HCPCS:L0642)

    2 DME suppliers used 26 Medicare Claims 26 Services Paid

Areas of Expertise

The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.

Established patient office or other outpatient visit, 10-19 minutes

This is a routine check-up for patients who have previously seen the doctor. During this 10-19 minute visit, the doctor will review your health status, discuss any concerns, and manage ongoing treatments or medications. It's a chance to ensure your health is on track.

This service was performed 13 times for 12 patients

Established patient office or other outpatient visit, 20-29 minutes

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

This service was performed 210 times for 152 patients

Established patient office or other outpatient visit, 30-39 minutes

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

This service was performed 208 times for 184 patients

Fusion of additional segment of spine

Fusion of an additional segment of the spine is a surgical procedure to join two or more vertebrae together. This is done to stabilize the spine and reduce pain or correct a deformity. The procedure involves using bone grafts, rods, or screws to secure the spine.

This service was performed 23 times for 13 patients

Fusion of lower spine bone through abdomen with partial removal of disc

This procedure involves merging the bones in your lower spine through an abdominal approach. A portion of the disc, which acts like a cushion between your vertebrae, is partially removed. The goal is to alleviate back pain by limiting movement in the problem area of your spine.

This service was performed 11 times for 11 patients

Fusion of spine in lower back

Fusion of the spine in the lower back, also known as lumbar spinal fusion, is a surgery aimed to join, or fuse, two or more vertebrae in your lower back. This procedure can help alleviate pain and improve stability by reducing movement between the vertebrae.

This service was performed 17 times for 17 patients

Fusion of spine in lower back with partial removal of spine bone and disc

This procedure, called lumbar spinal fusion, involves joining two or more vertebrae in your lower back. It includes a partial removal of a spine bone and disc to alleviate pain and improve stability. The goal is to reduce motion between vertebrae and prevent nerve irritation.

This service was performed 12 times for 12 patients

Injection, ketorolac tromethamine, per 15 mg

Ketorolac tromethamine is a medication administered through injection, often used to manage moderate to severe pain. Each 15 mg dose helps to reduce hormones causing inflammation and pain in the body. It is not recommended for long-term use.

This service was performed 31 times for 12 patients

Insertion of cage or mesh device to spine bone and disc space during spine fusion

Spine fusion is a procedure to join two or more vertebrae. During this process, a cage or mesh device is inserted into the spine bone and disc space. This helps to stabilize the spine, reduce pain, and improve functionality. The device acts as a bridge for new bone to grow on.

This service was performed 39 times for 31 patients

Laminectomy or laminotomy (partial removal of spine bones)

A laminectomy or laminotomy is a surgical procedure that involves removing part of the bone in your spine, specifically the lamina, to alleviate pressure on your spinal cord or nerves. This can help reduce pain and improve mobility if you're suffering from conditions like herniated discs or spinal stenosis.

This service was performed for 109 patients

Mri scan of lower spinal canal without contrast

An MRI scan of the lower spinal canal without contrast is a non-invasive imaging test. It uses a magnetic field and radio waves to produce detailed images of your lower spine. This helps identify issues like disc problems, tumors, or nerve conditions. No dye is used.

This service was performed 42 times for 42 patients

New patient office or other outpatient visit, 45-59 minutes

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

This service was performed 29 times for 29 patients

Partial removal of spine bone with release of lower spinal cord and/or nerves, 1 segment

This procedure involves removing part of a spine bone to alleviate pressure on the lower spinal cord and/or nerves. It targets a single segment of the spine, improving mobility and reducing pain. It's a common treatment for conditions like herniated discs or spinal stenosis.

This service was performed 53 times for 53 patients

Partial removal of spine bone with release of spinal cord and/or nerves, each additional segment

This procedure involves the partial removal of a bone in your spine to alleviate pressure on your spinal cord or nerves. It may be performed on multiple spine segments depending on your condition. The aim is to improve mobility and reduce pain or discomfort.

This service was performed 46 times for 39 patients

Placement of stabilizing device to back of 1 spine bone in neck

This procedure involves positioning a stabilizing device onto a single spinal bone in the neck. The goal is to provide support and prevent movement that could cause discomfort or further injury. It's performed by trained specialists under anesthesia.

This service was performed 16 times for 16 patients

Placement of stabilizing device to back, 3-6 spine bone segments

This procedure involves placing a device on your back to stabilize 3-6 spine bone segments. It aids in maintaining spine alignment and reducing pain. The device is secured to the bones, providing support and promoting healing.

This service was performed 12 times for 12 patients

Placement of stabilizing device to front, 2-3 spine bone segments

This procedure involves positioning a stabilizing device on the front of 2-3 segments of your spine. It's designed to provide support and stability to your spine, potentially alleviating discomfort and improving mobility.

This service was performed 21 times for 21 patients

Spinal fusion

Spinal fusion is a surgical procedure aimed at connecting two or more vertebrae in your spine to reduce pain and improve stability. It involves using a bone graft to cause the vertebrae to grow together, limiting the movement between them. This procedure is often performed to treat conditions like herniated discs or spinal stenosis.

This service was performed for 56 patients

X-ray of lower and sacral spine, 2-3 views

An X-ray of the lower and sacral spine involves capturing images of your lower back area, including the tailbone. This procedure helps in identifying problems like fractures, infections, or deformities. 2-3 different angle views provide a comprehensive picture.

This service was performed 421 times for 253 patients

X-ray of middle spine, 2 views

An X-ray of the middle spine, or thoracic spine, involves capturing two different images of the area. This non-invasive procedure uses small amounts of radiation to visualize the bones and tissues in your back, helping to identify any abnormalities or injuries.

This service was performed 33 times for 23 patients

X-ray of upper spine, 2-3 views

An X-ray of the upper spine, with 2-3 views, is a painless procedure that employs a small amount of radiation to capture images of your neck and upper back. It assists in diagnosing conditions like arthritis, fractures, or spinal deformities.

This service was performed 102 times for 64 patients

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NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1528173697
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2548276618
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 5 + 4 + 8 + 2 + 7 + 6 + 6 + 1 + 8 + 24 = 73
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
80 - 73 = 77

The NPI number 1528173697 is valid because the calculated check digit 7 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 7 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1942754957 JAIME VALDES PT
Individual
Physical Therapist1800 SE MOBERLY LN
BENTONVILLE, AR 72712
(479) 715-6330
1336693084 BROOKE NICOLE WARREN PT
Individual
Physical Therapist1800 SE MOBERLY LN
BENTONVILLE, AR 72712
(479) 715-6330
1467882084 LAURA HADLEY BUERGLER DPT
Individual
Physical Therapist1800 SE MOBERLY LN
BENTONVILLE, AR 72712
(479) 715-6330
1932436755 ANTHONY ADAIR DPT
Individual
Physical Therapist1800 SE MOBERLY LN
BENTONVILLE, AR 72712
(479) 715-6330
1235573577OZARK ORTHOPAEDICS, P.A.
Organization
Orthopaedic Surgery1800 SE MOBERLY LN STE B
BENTONVILLE, AR 72712
(479) 521-2752
1821319856DR. ROBERT ANGUS MACLEOD M.D.
Individual
Orthopaedic Surgery (Sports Medicine)1800 SE MOBERLY LN STE 4
BENTONVILLE, AR 72712
(479) 715-6600
1750882890 KAITLYN NICOLE EASTMAN JONES PT, DPT
Individual
Physical Therapist1800 SE MOBERLY LN
BENTONVILLE, AR 72712
(479) 715-6600

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1528173697, enumerated in the NPI registry as an "individual" on August 20, 2006

The provider is located at 1800 Se Moberly Ln Bentonville, Ar 72712 and the phone number is (479) 521-2752

The provider's speciality is Orthopaedic Surgery with taxonomy code 207XS0117X with a focus in Orthopaedic Surgery of the Spine

The provider has more than 26 years of experience. He graduated from Oregon Health Sciences University School Of Medicine in 2000.

The provider might be accepting Accepts: Arkansas Blue Cross and Blue Shield, Health. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.

Yes, as of June 20, 2025 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

The most common procedures or services performed by this practitioner are: Established patient office or other outpatient visit, 10-19 minutes, Established patient office or other outpatient visit, 20-29 minutes, Established patient office or other outpatient visit, 30-39 minutes, Fusion of additional segment of spine, Fusion of lower spine bone through abdomen with partial removal of disc, Fusion of spine in lower back, Fusion of spine in lower back with partial removal of spine bone and disc, Injection, ketorolac tromethamine, per 15 mg, Insertion of cage or mesh device to spine bone and disc space during spine fusion, Laminectomy or laminotomy (partial removal of spine bones), Mri scan of lower spinal canal without contrast, New patient office or other outpatient visit, 45-59 minutes, Partial removal of spine bone with release of lower spinal cord and/or nerves, 1 segment, Partial removal of spine bone with release of spinal cord and/or nerves, each additional segment, Placement of stabilizing device to back of 1 spine bone in neck, Placement of stabilizing device to back, 3-6 spine bone segments, Placement of stabilizing device to front, 2-3 spine bone segments, Spinal fusion, X-ray of lower and sacral spine, 2-3 views, X-ray of middle spine, 2 views and X-ray of upper spine, 2-3 views.

This NPI record was last updated on August 20, 2006. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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