The year this clinician's National Provider Identifier (NPI) was issued. An NPI is a unique 10-digit ID that US health care providers use for billing.

What this does not show

NPIs have been issued only since 2005, so this year is not necessarily when the clinician started practicing.

Source: CMS NPPES NPI Registry.

Medicare assignment not listed

CMS data do not show whether this clinician accepts Medicare assignment. This does not mean they do not accept Medicare. Ask the office.

Medicare assignment applies to Original Medicare. It does not tell you whether the clinician is in a Medicare Advantage plan's network, accepts other insurance, or is taking new patients.

Source: CMS Doctors and Clinicians; Medicare.gov, “Does your provider accept Medicare as full payment?”

Guide: What Medicare assignment means

No telehealth indicator

CMS shows this indicator only when recent Medicare claims include telehealth services. The clinician may still offer telehealth; ask the office.

Source: CMS, Telehealth Indicator on Medicare Care Compare (fact sheet, January 2023); CMS Doctors and Clinicians.

Guide: How Medicare covers telehealth

Sources: CMS Doctors and Clinicians, CMS NPPES NPI Registry. Specialty names follow the NUCC Health Care Provider Taxonomy.

Text: T-MedInfo · Report an error.

Specialties & License Numbers Reported to NPPES

Self-certified to NPPES: 2025-06-18

Non-emergency Medical Transport (VAN) Primary Specialty

NUCC Taxonomy Code: 343900000X

A land vehicle with a capacity to meet special height, clearance, access, and seating, for the conveyance of persons in non-emergency situations. The vehicle may or may not be required to meet local county or state regulations.

Check License Status with the State Board License numbers are self-reported to NPPES; T-MedInfo does not confirm them against state records. Current status: Oklahoma State Board of Medical Licensure.

Look Up on State Board Site

Career & Practice History Timeline

Changes recorded in monthly NPPES data files: addresses, names, credentials, specialties and NPI status

9 Historical Events

📍

Updated Practice Location June 18, 2025

Registered at 13965 MOSSY STONE WAY, EDMOND, OK 730255024 (Tel: 4052043389)

📍

Updated Business Mailing Address June 18, 2025

Registered at 13965 MOSSY STONE WAY, EDMOND, OK 730255024 (Tel: 4052043389)

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) June 18, 2025

Non-emergency Medical Transport (VAN)

✅

NPI Profile Active December 09, 2013

NPI status registered as active in NPPES database

📍

Practice Location (Initial Record) December 09, 2013

Registered at 19444 NORTHPARK CT, EDMOND, OK 730129601 (Tel: 4052043389)

📍

Business Mailing Address (Initial Record) December 09, 2013

Registered at 19444 NORTHPARK CT, EDMOND, OK 730129601 (Tel: 4052043389)

👤

Provider Name / Credentials (Initial Record) December 09, 2013

Recorded as RANDY LAKE

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) December 09, 2013

Behavior Analyst

🟢

Initial NPI Registration & Enumeration December 09, 2013

First registered as active Individual Practitioner in NPPES Database.

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NPI Administrative Meta

NPI Number: 1124459797

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: December 09, 2013

Last Update: June 18, 2025

Sole Proprietor: Yes

Update or Correct Profile

Mailing Address

13965 Mossy Stone Way

Edmond, OK 730255024

Phone: 4052043389

About This Data NPPES fields (address, phone, specialty, license) are self-reported and may be outdated; Medicare fields follow the CMS dataset named in each section. Correct directly at NPPES.