Randall C Dickson, PAC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

1001 North Broadway
Suite A11
Everett, WA 98201

Phone

(360) 658-4339

Fax

(360) 658-9868

NPI assigned

Jul 9, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617062400000",
    "number": "1215960372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 1ST AVE",
            "address_2": "UNIT 1001",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981212165",
            "telephone_number": "206-420-8115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 NORTH BROADWAY",
            "address_2": "SUITE A11",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "98201",
            "telephone_number": "360-658-4339",
            "fax_number": "360-658-9868"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2921 Naches Ave SW",
            "address_purpose": "LOCATION",
            "city": "Renton",
            "state": "WA",
            "postal_code": "980572617",
            "country_code": "US",
            "telephone_number": "206-630-1350",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DICKSON",
        "first_name": "RANDALL",
        "middle_name": "C",
        "name_prefix": "Mr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-09",
        "last_updated": "2021-03-30",
        "certification_date": "2021-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA10003610",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA10003610",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "2921 Naches Ave SW",
            "city": "Renton",
            "state": "WA",
            "country_code": "US",
            "postal_code": "980572617",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Dominic Theodore Diciro, MD
• Janice Marie Dickason, P.T.
• David Dickey, MD
• Kenneth Dickinson
• William E. Dickinson, DO
• Sarah Mae Dickson, NURSE PRACTITIONER
• Vicki Lynn Dickson, ARNP, FNP-BC
• Susan Diehl
• Justin R Diercks, PHARMD
• Dennis Edward Dilday, D.C.

• Medical Physician Assistant in Everett, WA
• Providers in Everett, WA by specialty
• Medical Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2021; 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.