Individual provider Active NPI

Michael Randolph, FNP-C

  • Family Nurse Practitioner
  • Maricopa, AZ
National Provider Identifier
1417764440
Registry record updated Apr 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
270365 Issued in AZ
Practice address
20046 N John Wayne Pkwy Ste 102
Maricopa, AZ 85139-2977
Phone
(520) 497-4575
NPI assigned
Dec 12, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 270365 AZ Primary

Addresses

Primary practice location

20046 N John Wayne Pkwy Ste 102
Maricopa, AZ 85139-2977

Mailing address

20046 N John Wayne Pkwy Ste 102
Maricopa, AZ 85139-2977
Phone (520) 497-4575

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250205003063 AZ Practitioner - Nurse Practitioner 5991235970 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Zuwa Family Care PLLCGroup PAC ID 6800297672, 2 clinicians

Practice addresses (Care Compare)

20046 N John Wayne Pkwy
Suite 102
Maricopa, AZ 85137
Phone (520) 497-4575

Hospital & facility affiliations

  • Sweetheart Healthcare LLC Home health agency, Chandler, AZ, CCN 037813

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
270365AZMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Zuwa Family Care PLLC Family CurrentSince Jan 1, 2025 Accepting new patients

Locations

20046 N John Wayne Pkwy
Ste 102
Maricopa, AZ 85139
Phone (520) 381-0048

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/23586/brand/1/csg/1/fhir/r4
  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1733961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745366400000",
    "number": "1417764440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20046 N JOHN WAYNE PKWY STE 102",
            "city": "MARICOPA",
            "state": "AZ",
            "postal_code": "851392977",
            "telephone_number": "520-497-4575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20046 N JOHN WAYNE PKWY STE 102",
            "city": "MARICOPA",
            "state": "AZ",
            "postal_code": "851392977",
            "telephone_number": "520-497-4575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "MICHAEL",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-12-12",
        "last_updated": "2025-04-23",
        "certification_date": "2025-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "270365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maricopa, AZ

Sources for this page

Verify at the official NPI Registry.