NPIMap

Organization Active NPI

Michigan Orthopaedics and Sports Medicine, PC

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Grand Rapids, MI
National Provider Identifier
1932174109
Registry record updated Oct 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
Legal business name
MICHIGAN ORTHOPAEDICS AND SPORTS MEDICINE, PC
Practice address
2911 Knapp St NE
Suite a
Grand Rapids, MI 49525
Phone
(616) 451-9925
Fax
(616) 451-9896
NPI assigned
Feb 21, 2006
Last updated
Oct 17, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2012

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

Authorized official

Name
Dr. Kyle Robert Randall, M.D.NPI 1154396364
Title
President
Phone
(616) 451-9925

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X NU Primary

Addresses

Primary practice location

2911 Knapp St NE
Suite a
Grand Rapids, MI 49525

Mailing address

2911 Knapp St NE
Suite a
Grand Rapids, MI 49525
Phone (616) 451-9925

National Provider Directory

National Provider Directory

Locations

2911 Knapp St NE
Ste A
Grand Rapids, MI 49525
Phone (616) 451-9925

350 Lafayette Ave SE
Ste 308A
Grand Rapids, MI 49503
Phone (616) 451-9925

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1140480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350432000000",
    "number": "1932174109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2911 KNAPP ST NE",
            "address_2": "SUITE A",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49525",
            "telephone_number": "616-451-9925",
            "fax_number": "616-328-5380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2911 KNAPP ST NE",
            "address_2": "SUITE A",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49525",
            "telephone_number": "616-451-9925",
            "fax_number": "616-451-9896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN ORTHOPAEDICS AND SPORTS MEDICINE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-21",
        "last_updated": "2012-10-17",
        "status": "A",
        "authorized_official_last_name": "RANDALL",
        "authorized_official_first_name": "KYLE",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "616-451-9925",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "NU",
            "license": null,
            "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 Oct 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.