Dr Austin Gonzalez-randolph, LP is a medicare enrolled "Psychologist" provider in South Milwaukee, Wisconsin. His current practice location is
712 Monroe Ave, South Milwaukee, Wisconsin. You can reach out to his office (for appointments etc.) via phone at
(425) 780-5094.
Dr Austin Gonzalez-randolph is licensed to practice in Washington (license number PY61278527) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1851975056.
Healthcare Provider's Profile
| Full Name | Dr Austin Gonzalez-randolph |
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| Gender | Male |
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| Speciality | Psychologist |
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| Location | 712 Monroe Ave, South Milwaukee, Wisconsin |
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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: 1851975056
- Provider Enumeration Date: 05/12/2021
- Last Update Date: 06/24/2025
Medicare PECOS Information:
- PECOS PAC ID: 4981075462
- Enrollment ID: I20230119002265
Medical Identifiers
Medical identifiers for Dr Austin Gonzalez-randolph such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1851975056 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 103T00000X | Psychologist | 4078-57 (Wisconsin) | Secondary |
| 103T00000X | Psychologist | PY61278527 (Washington) | 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 Austin Gonzalez-randolph allows following entities to bill medicare on his behalf.
| Entity Name | Mindful Therapy Group Pc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1316238678
PECOS PAC ID: 4981872561
Enrollment ID: O20110726000730 |
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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 Austin Gonzalez-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 |
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Dr Austin Gonzalez-randolph, LP
100 N Howard St Ste R,
Spokane, WA 99201-0508
Ph: (425) 780-5094 | Dr Austin Gonzalez-randolph, LP
712 Monroe Ave,
South Milwaukee, WI 53172-2126
Ph: (425) 780-5094 |
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