NPIMap

Individual provider Active NPI

Scot Randall, DO

  • Family Medicine Physician
  • Charlotte, MI
National Provider Identifier
1881611465
Registry record updated Jun 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
SR011391 Issued in MI
Practice address
111 Lansing St
Suite 100
Charlotte, MI 48813-2400
Phone
(517) 541-5962
Fax
(517) 541-5963
NPI assigned
Jul 17, 2006
Last updated
Jun 11, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X SR011391 MI Primary

Addresses

Primary practice location

111 Lansing St
Suite 100
Charlotte, MI 48813-2400

Mailing address

321 E Harris St
Charlotte, MI 48813-1629
Phone (517) 543-1050

Other identifiers 2

IdentifierTypeStateIssuer
4574654MedicaidMI
200000002577OtherMIPHP

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040428000907 MI Practitioner - General Practice 3779570031 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Michigan State University College of Osteopathic Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sparrow Eaton HospitalGroup PAC ID 0042103509, shared by 4 NPIs, 45 clinicians
Powerback Rehabilitation LLCGroup PAC ID 2365359932, shared by 106 NPIs, 600 clinicians

Practice addresses (Care Compare)

123 Lansing St
Suite 2
Charlotte, MI 48813-1696
Phone (517) 543-9500

5025 Ann Arbor Rd
Jackson, MI 49201-8801
Phone (517) 879-1505

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
SR011391MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sparrow Eaton Hospital CurrentSince Jan 1, 2004 Accepting new patients
S D Consulting Inc Family Medicine CurrentSince Dec 21, 2024 Accepting new patients
Sparrow Eaton Hospital CurrentSince Jan 1, 2004 Accepting new patients
Sparrow Eaton Hospital CurrentSince Nov 23, 2025 Accepting new patients
John F Smarch DC PC PastSince Mar 1, 2005 Accepting new patients
Sparrow Eaton Hospital Family Medicine Past Accepting new patients
Sparrow Eaton Hospital Past Accepting new patients

Locations

8175 Reliable Pkwy
Chicago, IL 60686

30150 Telegraph Rd
Ste 371
Bingham Farms, MI 48025
Phone (734) 493-1662

321 E Harris St
Charlotte, MI 48813
Phone (517) 541-5840

123 Lansing St
Ste 3A
Charlotte, MI 48813
Phone (517) 543-0600

123 Lansing St
Ste 2
Charlotte, MI 48813
Phone (517) 541-5954

111 Lansing St
Ste 100
Charlotte, MI 48813
Phone (517) 364-5550

111 Lansing St
Ste 110
Charlotte, MI 48813
Phone (517) 541-5855

Interoperability endpoints

  • Direct secure messaging: srandall69030@sparrowdirecthie.org

Organizations & group practices 7

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.

Hospital & facility affiliations 6

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": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339372800000",
    "number": "1881611465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 E HARRIS ST",
            "city": "CHARLOTTE",
            "state": "MI",
            "postal_code": "488131629",
            "telephone_number": "517-543-1050",
            "fax_number": "517-541-5870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 LANSING ST",
            "address_2": "SUITE 100",
            "city": "CHARLOTTE",
            "state": "MI",
            "postal_code": "488132400",
            "telephone_number": "517-541-5962",
            "fax_number": "517-541-5963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDALL",
        "first_name": "SCOT",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2012-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "SR011391",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4574654",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP",
            "identifier": "200000002577",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, MI

Sources for this page

Verify at the official NPI Registry.