Randall L Wolthuis, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301006480 Issued in MI

Practice address

8202 Triple L TRL SE
Alto, MI 49302-9551

Phone

(616) 275-2113

NPI assigned

May 2, 2007

Last updated

Mar 21, 2024By 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: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1987

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

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.

• Randall Wolthuis, PH.D. LLC

  • Psychologist
  • Alto, MI
  • NPI 1174160550
  Authorized official Same address or phone
• Marvin Behavioral Health Ma PC

  • Psychologist
  • Boston, MA
  • NPI 1740860428
  NPD (past)

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710979200000",
    "number": "1639390743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 PARCHMENT DRIVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495463663",
            "telephone_number": "616-957-9112",
            "fax_number": "616-957-2409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8202 TRIPLE L TRL SE",
            "city": "ALTO",
            "state": "MI",
            "postal_code": "493029551",
            "telephone_number": "616-275-2113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLTHUIS",
        "first_name": "RANDALL",
        "middle_name": "L",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-02",
        "last_updated": "2024-03-21",
        "certification_date": "2024-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301006480",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PIN",
            "identifier": "680D145940",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathryn Tompkins
• Ulyses Dewey Corporation (SarahCare Knapps Corner)
• Visel Afc, Inc.
• West Michigan Hospice, LLC
• West Michigan Palliative

• Clinical Psychologist in Alto, MI
• Providers in Alto, MI by specialty
• Clinical Psychologist in Michigan

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