Martin Randall, MD
Individual provider Active NPI Pediatrics Physician · Chlesea, MI
NPI 1992328330 · NPPES record last updated May 7, 2023
Key facts
- NPI
- 1992328330
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 4301509245 (MI)
- Practice address
- 13699 E. Old US Highway 12
Chlesea, MI 48118-5097 - Phone
- (734) 475-4500
- Fax
- (734) 475-4507
- NPI assigned
- May 20, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200604000706 | MI | Order and Referring Only - Pediatric Medicine |
4082035738 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301509245 | MI | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pediatric Care of Chelsea, PC | Pediatrics | Past |
Accepting new patients |
Interoperability endpoints
- mrandall890547@direct.hfhs.org
- https://api.platform.athenahealth.com/3566/brand/1/csg/1/fhir/r4
- martin.randall.1@33161.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 4301509245 | MI | Yes |
Addresses
Primary practice location
13699 E. Old US Highway 12
Chlesea, MI 48118-5097
Mailing address
13699 E. Old US Highway 12
Chlesea, MI 48118
Phone (734) 475-4500
Other providers in Chlesea, MI
All providers in Chlesea, MI · Pediatrics Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.