Randall Lee Herrema, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301003721 Issued in MI

Practice address

3501 Lake Eastbrook Blvd SE
Suite 280
Grand Rapids, MI 49546-5938

Phone

(616) 942-7331

NPI assigned

Jan 4, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Centennial Park Counseling PLLCGroup PAC ID 7517340557, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Centennial Park Counseling, PLLC

  • Social Worker
  • Grand Rapids, MI
  • NPI 1689814469
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1063569150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3501 LAKE EASTBROOK BLVD SE",
            "address_2": "SUITE 280",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49546",
            "telephone_number": "616-942-7331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3501 LAKE EASTBROOK BLVD SE",
            "address_2": "SUITE 280",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495465938",
            "telephone_number": "616-942-7331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERREMA",
        "first_name": "RANDALL",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301003721",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeremy Richard Herr, MS, FNP, APNP
• Megan Herr
• Maria Herrala, LMSW
• Sarajane Ann Herrboldt, LLPC
• Elizabeth Herrema, LLBSW
• Thomas Edward Herremans, DDS MPH MS
• Dylan Thomas Herrera
• Sophia Cynthia Herrera
• Veronica Herrera
• Yoisler Herrera Sr., M.D

• Clinical Psychologist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.

Verify at the official NPI Registry.