Active NPI
Kevin Randa, LPCC
- Professional Counselor
- Cloquet, MN
National Provider Identifier
1023854809
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 4342
- Practice address
- 927 Trettel LN
Cloquet, MN 55720-1345 - Phone
- (218) 879-1227
- NPI assigned
- Jul 2, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 4342 | MN | Primary |
Addresses
Primary practice location
927 Trettel LN
Cloquet, MN 55720-1345
Mailing address
2802 Dewey Ave
Cloquet, MN 55720-2754
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 2002
- Medicare assignment
- May accept Medicare assignment
- Group practices
Practice addresses (Care Compare)
927 Trettel LN
Cloquet, MN 55720-1345
Phone (218) 879-1227
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4342 | MN | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fond Du Lac Reservation Business Committee | Current | Accepting new patients | |
| Fond Du Lac Reservation Business Committee | Current | Accepting new patients |
Locations
927 Trettel Ln
Cloquet, MN 55720
Phone (218) 879-1227
Interoperability endpoints
- kevin.randa.p1@direct.fonddulachsd.nextgenshare.com
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinic/Center
- Cloquet, MN
- NPI 1326053166
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Cloquet, MN
- NPI 1053772087
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1719878400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730332800000",
"number": "1023854809",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2802 DEWEY AVE",
"city": "CLOQUET",
"state": "MN",
"postal_code": "557202754"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "927 TRETTEL LN",
"city": "CLOQUET",
"state": "MN",
"postal_code": "557201345",
"telephone_number": "218-879-1227"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDA",
"first_name": "KEVIN",
"credential": "LPCC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-07-02",
"last_updated": "2024-10-31",
"certification_date": "2024-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MN",
"license": "4342",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cloquet, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.