Individual provider Active NPI

Darius Lamont Randall, LMSW

  • Mental Health Counselor
  • Grand Rapids, MI
National Provider Identifier
1720201742
Registry record updated May 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
1720201742 Issued in MI
Practice address
4500 Cascade Rd SE
Grand Rapids, MI 49546-3665
Phone
(616) 443-4121
Fax
(616) 469-1124
NPI assigned
Apr 10, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 24, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 1720201742 MI Primary

Addresses

Primary practice location

4500 Cascade Rd SE
Grand Rapids, MI 49546-3665

Mailing address

9578 Snow Valley Dr SE
Alto, MI 49302-8989
Phone (616) 287-5331

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
87.49 of 100Reported as group
Quality
78.04
Promoting interoperability
100
Improvement activities
40
Cost
75.09

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1720201742MIMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Fresh Sands Counseling & Consulting LLC Clinical CurrentSince May 26, 2024 Accepting new patients
Kathryn Bultman L.L.C. Clinical Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716508800000",
    "number": "1720201742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9578 SNOW VALLEY DR SE",
            "city": "ALTO",
            "state": "MI",
            "postal_code": "493028989",
            "telephone_number": "616-287-5331",
            "fax_number": "616-469-1124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 CASCADE RD SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495463665",
            "telephone_number": "616-443-4121",
            "fax_number": "616-469-1124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDALL",
        "first_name": "DARIUS",
        "middle_name": "LAMONT",
        "name_prefix": "Mr.",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-10",
        "last_updated": "2024-05-24",
        "certification_date": "2024-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MI",
            "license": "1720201742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.