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DR. RANDALL WILLIAM GREEN MD
NPI 1467400333
Specialist in Grand Rapids, MI

Active since May 04, 2006Opted out of Medicare · through Jul 1, 2027
4070 LAKE DR SE, GRAND RAPIDS, MI 49546(616) 774-8200(616) 774-0304 Get Directions Write a Review

NPPES record last updated: March 7, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Dr. Randall William Green Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. RANDALL WILLIAM GREEN MD (NPI 1467400333) is an individual specialist in Grand Rapids, Michigan, licensed in Michigan (RG030071) and active in the NPI registry since May 2006. He has opted out of Medicare through July 1, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1467400333
Entity TypeIndividualMale
Primary Taxonomy174400000X
Provider Legal NameDR. RANDALL WILLIAM GREENCredential: MD
Location Address4070 LAKE DR SEGrand Rapids, MI 49546-8294
Mailing Address4070 Lake Dr SeGrand Rapids, MI 49546-8294 · (616) 774-8200 · Fax (616) 774-0304
Phone(616) 774-8200
Fax(616) 774-0304
Sole ProprietorYes
Enumeration DateMay 4, 2006
Last NPPES UpdateMarch 7, 2023
✔ NPI 1467400333 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in MI · RG030071
Definition

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.

4070 LAKE DR SE, Grand Rapids, MI 49546
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Other Identifiers 4

Other110158828MI · Railroad Medicare
OtherRG030071MI · State License Number
Other1104110132MI · Blue Cross Blue Shield
Medicaid1073594MI

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Randall William Green Md has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from July 1, 2017 through July 1, 2027.

Opt-Out Effective DateJuly 1, 2017
Opt-Out In Effect ThroughJuly 1, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Other Providers at the Same Location NPPES 15

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. KATIE R UGOLINI M.D.
Specialist
4070 LAKE DR SE, SUITE 202
GRAND RAPIDS, MI 49546
Kent County (616) 464-4420
DR. TIFFANY LAUREN KENT MD, PHD
Ophthalmology (Ophthalmic Plastic and Reconstructive Surgery)
4070 LAKE DR SE, SUITE 205
GRAND RAPIDS, MI 49546
Kent County (616) 888-2948
OCULOPLASTIC ASSOCIATES OF WEST MICHIGAN, PLC
Ophthalmology (Ophthalmic Plastic and Reconstructive Surgery)
4070 LAKE DR SE, SUITE 205
GRAND RAPIDS, MI 49546
Kent County (616) 888-2948
CENTER FOR BREAST & BODY CONTOURING PC
Specialist
4070 LAKE DR SE, SUITE 202
GRAND RAPIDS, MI 49546
Kent County (616) 464-4420
JOHN G FORD OD
Optometrist
4070 LAKE DR SE, SUITE 101
GRAND RAPIDS, MI 49546
Kent County (616) 949-8500
PHYSICAL THERAPY SERVICES OF GRAND RAPIDS, LLC
Clinic/Center (Physical Therapy)
4070 LAKE DR SE, SUITE: 204
GRAND RAPIDS, MI 49546
Kent County (616) 481-3690
MICHAEL EDWARD NOVAK M.D.
Urology
4070 LAKE DR SE
GRAND RAPIDS, MI 49546
Kent County (616) 949-4340
KENNETH W POST MD PLC
Surgery
4070 LAKE DR SE
GRAND RAPIDS, MI 49546
Kent County (616) 954-1763

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Randall Green's NPI number?

The NPI number for Randall Green is 1467400333. It was assigned to this individual provider in the NPPES registry on May 4, 2006.

Where is Randall Green located?

Randall Green practices at 4070 Lake Dr SE, Grand Rapids, MI 49546. The listed phone number is (616) 774-8200.

What is Randall Green's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is Randall Green enrolled in Medicare?

No. Randall Green has opted out of Medicare through July 1, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Randall Green was last updated on March 7, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.