CHAD LARSEN RANDOL (APRN) – Family Nurse Practitioner, NPI 1205513942

CHAD LARSEN RANDOL (APRN) is a healthcare provider. based in Indialantic, Florida. specializing in NURSE PRACTITIONER. They hold the professional credentials APRN. They hold a License No. 11027198 (FL). The NPI Number for CHAD LARSEN RANDOL (APRN) is 1205513942

Main info

Male
3 Years Of Experience
Accepts Medicare Assignment
Name
CHAD LARSEN RANDOL (APRN)
NPI
1205513942
Phone
(859) 428-6492
Address
351 COCONUT DR
Enumeration Date
4 July 2023
Last Update Date
4 July 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3217521200
Graduation Year
2023 (3 years ago)
PAC ID
6406290543
Group Practice PAC ID
2860783925
Professional Enrollment ID
I20240216002846
Address ID
FL329358625ME250XXRDXX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience28
Completeness75
Years active:2State licenses:1Digital endpointsOther names

24,232 NURSE PRACTITIONER in FL

Provider Addresses for CHAD LARSEN RANDOL (APRN)

  • 351 COCONUT DR

    INDIALANTIC, FL 329033843

    Phone: (859) 428-6492

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2024-02-16

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20240216002846INurse PractitionerFLTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 32903)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 2860783925View full group profile
NameSpecialtyState
-FL
Emergency MedicineFL
Emergency MedicineFL
Emergency MedicineFL
Emergency MedicineFL
Emergency MedicineFL
Internal MedicineFL
Emergency MedicineWV

Reviews

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Frequently asked questions

Can I verify CHAD LARSEN RANDOL (APRN) with an NPI only?
You can start verification with NPI 1205513942 for CHAD LARSEN RANDOL (APRN), then check state licensing separately.
Is CHAD LARSEN RANDOL (APRN) listed as active for patients and plans?
The listing shows CHAD LARSEN RANDOL (APRN) as active in the NPI system.
What is CHAD LARSEN RANDOL (APRN)'s primary classification?
Family Nurse Practitioner is the headline specialty for CHAD LARSEN RANDOL (APRN) here. Clinical services aligned with this taxonomy classification.
Where should I expect CHAD LARSEN RANDOL (APRN) on a map?
Expect Indialantic, Florida as a primary anchor for CHAD LARSEN RANDOL (APRN) unless the record lists multiple sites.
Is specialty guaranteed by NPI alone?
Taxonomy selections describe intent; scope of practice still follows state law.

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