Riverwood Family Medicine PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

RIVERWOOD FAMILY MEDICINE PC

Practice address

3299 Clear Vista CT NE
Suite C
Grand Rapids, MI 49525-9477

Phone

(616) 361-1200

Fax

(616) 361-2198

NPI assigned

Nov 17, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Randall N Clark, M.D.NPI 1063573319

Title

Vice President

Phone

(616) 361-1178

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Randall Norton Clark, MD

  • Family Medicine Physician
  • Grandville, MI
  • NPI 1063573319
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303344000000",
    "number": "1972677656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3299 CLEAR VISTA CT NE",
            "address_2": "SUITE C",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259477",
            "telephone_number": "616-361-1200",
            "fax_number": "616-361-2198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3299 CLEAR VISTA CT NE",
            "address_2": "SUITE C",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259477",
            "telephone_number": "616-361-1200",
            "fax_number": "616-361-2198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERWOOD FAMILY MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2011-04-21",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "616-361-1178",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "080D148480",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Olivia Lee Rivera, PA-C
• Ronald Christian Rivera, LMSW
• Samantha Jean Rivera, M.S. CCC-SLP
• John Rivero
• Riverside Psychiatric Services PLLC
• Stacey Lynn Rivet, FNP
• Bridget Ann Rizik
• Christopher Rizik
• John Paul Rizik, DO
• Syed Ali Rizvi, M.D.

• Family Medicine Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.