Kyle Robert Randall, MD

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

4301061642 Issued in MI

Practice address

2911 Knapp St NE
Suite a
Grand Rapids, MI 49525

Phone

(616) 451-9925

Fax

(616) 328-5380

NPI assigned

Feb 21, 2006

Last updated

Nov 21, 2014By the provider in NPPES

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

Other identifiers 1

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

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kyle.randall.1@22710.direct.athenahealth.com

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.

• Dickinson County Healthcare System

  dba Marshfield Medical Center - Dickinson Professional Services

  • Emergency Medical Services (Emergency Medicine) Physician
  • Iron Mountain, MI
  • NPI 1891751186

  Orthopaedic Surgery

  Medicare reassignment NPD
• Schoolcraft Memorial Hospital

  • Critical Access Hospital
  • Manistique, MI
  • NPI 1700805157
  Medicare reassignment NPD
• Michigan Orthopaedics and Sports Medicine, PC

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Grand Rapids, MI
  • NPI 1932174109
  Authorized official Same address or phone

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

{
    "created_epoch": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416528000000",
    "number": "1154396364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2911 KNAPP ST NE",
            "address_2": "SUITE A",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49525",
            "telephone_number": "616-451-9925",
            "fax_number": "616-328-5380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2911 KNAPP ST NE",
            "address_2": "SUITE A",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49525",
            "telephone_number": "616-451-9925",
            "fax_number": "616-328-5380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDALL",
        "first_name": "KYLE",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-21",
        "last_updated": "2014-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MI",
            "license": "4301061642",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4334872-10",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Allison M Randall, PA-C
• Amber Randall
• Bonnie Jean Elizabeth Randall, P.T.
• Darius Lamont Randall, LMSW
• Grady S Randall, DDS
• Linnea Randall, LMSW
• Susan Leclaire Randall
• Tricia Randall, HEALTH COACH
• Gianna Randazzo
• Annastasha Marie Randle

• Orthopaedic Surgery Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Orthopaedic Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2014; 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.