Randall Norton Clark, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

RC050413 Issued in MI

Practice address

3980 Chicago Dr SW Ste 200
Grandville, MI 49418-1392

Phone

(616) 381-5181

Fax

(616) 381-5178

NPI assigned

Dec 12, 2006

Last updated

Jul 18, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/IEGEDD/Endpoint/IEGEDD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Riverwood Family Medicine PC

  • Family Medicine Physician
  • Grand Rapids, MI
  • NPI 1972677656
  Medicare reassignment Authorized official
• Family Chiropractic Healthcare Center, PLLC

  • Chiropractor
  • Grand Rapids, MI
  • NPI 1598003717
  NPD (past)

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752796800000",
    "number": "1063573319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3980 CHICAGO DR SW STE 200",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494181392",
            "telephone_number": "616-381-5181",
            "fax_number": "616-381-5178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3980 CHICAGO DR SW STE 200",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494181392",
            "telephone_number": "616-381-5181",
            "fax_number": "616-381-5178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "RANDALL",
        "middle_name": "NORTON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-12",
        "last_updated": "2025-07-18",
        "certification_date": "2025-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "RC050413",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER ID",
            "identifier": "080D14848",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2851933",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "RC050413",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brian Lee Cilla, DDS MS
• Emily Cin
• Althea Rose Clarey-Schultz
• James Edward Clarey, RPH
• Chaniya Clark, LLBSW
• Clinical Psychiatric Medicine PC
• Stephen D Cohle, MD
• Collaborative Counseling Group PLLC
• Alissa Collins
• Jennifer O Collins, PHD

• Family Medicine Physician in Grandville, MI
• Providers in Grandville, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.