Jason Randall, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301014496 Issued in MI

Practice address

3770 Glenkerry CT
Portage, MI 49024-0700

Phone

(269) 329-2887

Fax

(269) 329-2805

NPI assigned

Jul 7, 2010

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

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

Loma Linda University School of Medicine, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Grace Health IncGroup PAC ID 1052229226, 29 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jason.randall.p1@direct.gracehealthmi.nextgenshare.com

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.

• Grace Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Battle Creek, MI
  • NPI 1518945278
  Medicare reassignment Care Compare group NPD
• Grace Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Battle Creek, MI
  • NPI 1942058458
  NPD
• Southern Michigan Pain Consultants PC

  • Interventional Pain Medicine Physician
  • Portage, MI
  • NPI 1538119391
  NPD (past)

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

{
    "created_epoch": "1278460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278460800000",
    "number": "1679885602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "61 COMMERCE AVE SW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034124",
            "telephone_number": "616-940-0660",
            "fax_number": "616-940-1965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3770 GLENKERRY CT",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490240700",
            "telephone_number": "269-329-2887",
            "fax_number": "269-329-2805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDALL",
        "first_name": "JASON",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-07",
        "last_updated": "2010-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301014496",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy Lewis Radabaugh, MA, LLP
• Sarah Radke
• Douglas John Raedy, D.O
• Rahaf Kanawati Dental PC
• Alyssa Ramsey
• Ryan Michael Ranger, LLMSW
• Annie Rose Rashes
• Heather Ratliff, R.N.
• Krystal Rau, LPC
• Cassie Ray

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2010; 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.