Individual provider Active NPI

Randall Klein, PA

  • Physician Assistant
  • Holland, MI
National Provider Identifier
1770525743
Registry record updated Feb 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601002654 Issued in MI
Practice address
602 Michigan Ave
Holland, MI 49423-4918
Phone
(616) 392-3824
Fax
(616) 494-5950
NPI assigned
Jun 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601002654 MI Primary

Addresses

Primary practice location

602 Michigan Ave
Holland, MI 49423-4918

Mailing address

100 Michigan St NE
MC 845
Grand Rapids, MI 49503-2560

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address rkleinpa8243@epic00.shdirect.org
FHIR URL https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/DSTU2/

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050727000905 MI Practitioner - Physician Assistant 2466480876 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Spectrum Health Primary Care PartnersGroup PAC ID 4587568647, 2,283 clinicians

Practice addresses (Care Compare)

2249 Wealthy St SE
110 Corewell Health Medical Group West
East Grand Rapids, MI 49506-3055
Phone (616) 391-4600

4444 Kalamazoo Ave SE
200 Corewell Health Medical Group West
Kentwood, MI 49508-4600
Phone (616) 391-5600

602 Michigan Ave
Suite 102
Holland, MI 49423-4918
Phone (616) 494-8724

8333 Felch St
Suite 100
Zeeland, MI 49464-2610
Phone (616) 494-8724

Hospital & facility affiliations

  • Spectrum Health Hospital, Grand Rapids, MI, CCN 230038
  • Holland Hospital Hospital, Holland, MI, CCN 230072
  • Corewell Health Zeeland Hospital Hospital, Zeeland, MI, CCN 230003

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5601002654MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Spectrum Health Primary Care Partners CurrentSince Jan 1, 2011 Accepting new patients
Spectrum Health Primary Care Partners CurrentSince Jan 1, 2011 Accepting new patients
Spectrum Health Primary Care Partners Current Accepting new patients
Michigan Medical Patient Care Past Accepting new patients
Michigan Medical Patient Care Cardiovascular Disease Past Accepting new patients
West Michigan Heart Cardiovascular Disease Past Accepting new patients

Locations

1300 Michigan St NE
Ste 103
Grand Rapids, MI 49503
Phone (616) 459-8338

4100 Lake Dr SE
Ste 202
Grand Rapids, MI 49546
Phone (616) 974-4400

100 Michigan St NE
#845
Grand Rapids, MI 49503
Phone (616) 391-8242

2249 Wealthy St SE
Ste 110
Grand Rapids, MI 49506
Phone (616) 391-4600

4085 Burton St SE
Ste 200
Grand Rapids, MI 49546

2900 Bradford St NE
Grand Rapids, MI 49525

1005 W Green St
Hastings, MI 49058
Phone (269) 948-8057

602 Michigan Ave
Holland, MI 49423
Phone (616) 394-3350

602 Michigan Ave
Ste 102
Holland, MI 49423
Phone (616) 392-3824

3152 Port Sheldon St
Hudsonville, MI 49426
Phone (616) 669-3558

4444 Kalamazoo Ave SE
Ste 200
Kentwood, MI 49508
Phone (616) 391-5600

8333 Felch St
Ste 100
Zeeland, MI 49464
Phone (616) 494-8724

100 Pine St
Ste 203
Zeeland, MI 49464
Phone (616) 748-2850

100 Pine St
Zeeland, MI 49464
Phone (616) 748-2850

Interoperability endpoints

  • Direct secure messaging: rklein8243@epic00.corewelldirect.org

Organizations & group practices 6

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614211200000",
    "number": "1770525743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "address_2": "MC 845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 MICHIGAN AVE",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494234918",
            "telephone_number": "616-392-3824",
            "fax_number": "616-494-5950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLEIN",
        "first_name": "RANDALL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2021-02-25",
        "certification_date": "2021-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601002654",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rkleinpa8243@epic00.shdirect.org",
            "affiliation": "N",
            "address_1": "602 Michigan Ave",
            "city": "Holland",
            "state": "MI",
            "country_code": "US",
            "postal_code": "494234918",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "602 Michigan Ave",
            "city": "Holland",
            "state": "MI",
            "country_code": "US",
            "postal_code": "494234918",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Holland, MI

Sources for this page

Verify at the official NPI Registry.