DR. RANDALL WILLIAM GREEN MD
NPI 1467400333
Specialist in Grand Rapids, MI
NPI Status: Active since May 04, 2006
Contact Information
4070 LAKE DR SE
GRAND RAPIDS, MI
ZIP 49546
Phone: (616) 774-8200
Fax: (616) 774-0304
- Individual
- Male
- Specialist
- PECOS Enrolled
- Opted-Out Medicare
About RANDALL GREEN
This page provides the complete NPI Profile along with additional information for Randall Green, a provider established in Grand Rapids, Michigan with a medical specialization in Specialist. The healthcare provider is registered in the NPI registry with number 1467400333 assigned on May 2006. The practitioner's primary taxonomy code is 174400000X with license number RG030071 (MI). The provider is registered as an individual and his NPI record was last updated 3 years ago.
- NPI
- 1467400333
- Provider Name
- DR. RANDALL WILLIAM GREEN MD
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 4070 LAKE DR SE GRAND RAPIDS, MI 49546
- Location Phone
- (616) 774-8200
- Location Fax
- (616) 774-0304
- Mailing Address
- 4070 LAKE DR SE GRAND RAPIDS, MI 49546
- Mailing Phone
- (616) 774-8200
- Mailing Fax
- (616) 774-0304
- Is Sole Proprietor?
- Yes
- Enumeration Date
- 05-04-2006
- Last Update Date
- 03-07-2023
- Code Navigator
The provider doesn't accept Medicare and has signed an affidavit to be excluded from the Medicare program. If you are a Medicare beneficiary this means a provider can charge whatever they want for services rendered but must follow certain rules to do so. Randall Green opted out of Medicare effective on 07-01-2017 until 07-01-2027. Opt out periods last for two years and cannot be terminated unless the provider is opting out for the very first time and the affidavit is terminated no later than 90 days after the opt out effective date. Opt-out affidavits might renew automatically renew every two years. The provider opted out of Medicare but is permitted to order and refer services to other healthcare providers.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Specialist
- Taxonomy Code
- 174400000X
- Type
- Other Service Providers
- License No.
- RG030071
- License State
- MI
- Taxonomy Description
- An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 110158828 | OTHER (01) | MI | RAILROAD MEDICARE |
| RG030071 | OTHER (01) | MI | STATE LICENSE NUMBER |
| 1104110132 | OTHER (01) | MI | BLUE CROSS BLUE SHIELD |
| 1073594 | MEDICAID (05) | MI |
Medicare Participation & PECOS Enrollment Status
Randall Green is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
Opted-Out of Medicare? Yes
Opt-Out Effective Date: 07-01-2017
Opt-Out End Date: 07-01-2027
Eligible to Order and Refer? Yes
Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1467400333, we treat the final digit (3) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 57. The final step is to find the difference between that total and the next multiple of ten (60 - 57 = 3).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 57 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 16 providers are registered at the same or a nearby location.
GRAND RAPIDS, MI 49546
GRAND RAPIDS, MI 49546
GRAND RAPIDS, MI 49546
GRAND RAPIDS, MI 49546
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1467400333, enumerated as an "individual" on May 04, 2006.
The provider is located at 4070 LAKE DR SE GRAND RAPIDS, MI 49546 and the phone number is (616) 774-8200.
Specialist with taxonomy code 174400000X.
The provider might be accepting Accepts: Railroad Medicare, Medicare, Medicaid and Blue. Please consult your insurance carrier or call the provider to verify.
