Individual provider Active NPI

Randy Scott Torres Jr., FNP-C

  • Family Nurse Practitioner
  • Southfield, MI
National Provider Identifier
1104345370
Registry record updated Sep 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704261502 Issued in MI
Practice address
29877 Telegraph Rd Ste 200
Southfield, MI 48034-7659
Phone
(248) 354-0730
NPI assigned
Sep 19, 2017
Last updated
Sep 19, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704261502 MI Primary

Addresses

Primary practice location

29877 Telegraph Rd Ste 200
Southfield, MI 48034-7659

Mailing address

1212 N Selfridge Blvd
Clawson, MI 48017-1006
Phone (734) 560-7720

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171109000437 MI Practitioner - Nurse Practitioner 7416213301 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Msu Health Care Inc.Group PAC ID 8628404936, 201 clinicians

Practice addresses (Care Compare)

804 Service Rd
East Lansing, MI 48824-7015
Phone (517) 355-2822

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704261502MIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Michigan Premier Geriatrics PLLC CurrentSince Oct 9, 2017 Accepting new patients

Locations

29877 Telegraph Rd
Ste 2
Southfield, MI 48034

29877 Telegraph Rd
Ste 200
Southfield, MI 48034
Phone (248) 354-0730

Interoperability endpoints

  • Direct secure messaging: randy.torres.1@11987.direct.athenahealth.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1505779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1505779200000",
    "number": "1104345370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1212 N SELFRIDGE BLVD",
            "city": "CLAWSON",
            "state": "MI",
            "postal_code": "480171006",
            "telephone_number": "734-560-7720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29877 TELEGRAPH RD STE 200",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480347659",
            "telephone_number": "248-354-0730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TORRES",
        "first_name": "RANDY",
        "middle_name": "SCOTT",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-19",
        "last_updated": "2017-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704261502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

Verify at the official NPI Registry.