Active NPI
Adam M Randazzo, PA-C
- Physician Assistant
- Port Huron, MI
National Provider Identifier
1629868559
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 1221 Pine Grove Ave
Port Huron, MI 48060-3511 - Phone
- (810) 987-5000
- NPI assigned
- May 12, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | MI | Primary |
Addresses
Primary practice location
1221 Pine Grove Ave
Port Huron, MI 48060-3511
Mailing address
2294 Zink Rd Apt 11
Beavercreek, OH 45324-6216
Phone (586) 894-2457
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2026
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1 McLaren Pkwy
Grand Blanc, MI 48439-7471
1231 Pine Grove Ave
Suite 1a
Port Huron, MI 48060-3500
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cedarville University | Past | Accepting new patients | |
| Cedarville University EMS | Past | Accepting new patients |
Organizations & group practices 3
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.
-
dba Port Huron Hospital Physician GRP
- Psychiatry Physician
- Port Huron, MI
- NPI 1386888170
-
dba University Medical Services
- Student Health Clinic/Center
- Cedarville, OH
- NPI 1174680318
-
- Ambulance
- Cedarville, OH
- NPI 1689910093
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1747008000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1781222400000",
"number": "1629868559",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2294 ZINK RD APT 11",
"city": "BEAVERCREEK",
"state": "OH",
"postal_code": "453246216",
"telephone_number": "586-894-2457"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1221 PINE GROVE AVE",
"city": "PORT HURON",
"state": "MI",
"postal_code": "480603511",
"telephone_number": "810-987-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDAZZO",
"first_name": "ADAM",
"middle_name": "M",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-05-12",
"last_updated": "2026-06-12",
"certification_date": "2026-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Huron, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2026; 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.