Randall Edward Surque, LPC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

6401016161 Issued in MI

Practice address

1200 N West Ave
Jackson, MI 49202-2179

Phone

(517) 789-1200

Fax

(517) 789-1276

NPI assigned

Oct 19, 2018

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 1

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

Mental Health Counselor

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jackson-Hillsdale Community Mental Health BoardGroup PAC ID 6406808062, 27 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.

• Jackson-Hillsdale Community Mental Health Board

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Jackson, MI
  • NPI 1063466274
  Medicare reassignment Care Compare group NPD
• Jackson-Hillsdale Community Mental Health Board

  • Psychiatric Residential Treatment Facility
  • Jackson, MI
  • NPI 1891417085
  NPD

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

{
    "created_epoch": "1539907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730246400000",
    "number": "1447726146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 N WEST AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492022179",
            "telephone_number": "517-789-1200",
            "fax_number": "517-789-1276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 N WEST AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492022179",
            "telephone_number": "517-789-1200",
            "fax_number": "517-789-1276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SURQUE",
        "first_name": "RANDALL",
        "middle_name": "EDWARD",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-19",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MI",
            "license": "6401016161",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "6401016161",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Summit Pointe Dental Group PLLC
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• Superior Transitional Care PLLC
• Surgical Services of Michigan, LLC
• Susan C. Guerriero Counseling Service
• Susan E. Arcaro
• Tracie Jo Sutliff
• Kristi Marie Sutton, RDH
• SVS Vision Inc

• Counselor in Jackson, MI
• Providers in Jackson, MI by specialty
• Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 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.

Verify at the official NPI Registry.