Courtney Dyan Randolph, ARNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP61372574 Issued in WA

Practice address

10004 204TH Ave E FL 3
Bonney Lake, WA 98391-6539

Phone

(253) 848-5951

Fax

(253) 845-7073

NPI assigned

Nov 30, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

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

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Multicare Health SystemGroup PAC ID 7719899897, 2,312 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tacoma General Allenmore Hospital Hospital, Tacoma, WA, CCN 500129

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Multicare Health System

  • Neurological Surgery Physician
  • Tacoma, WA
  • NPI 1497766638
  Medicare reassignment Care Compare group NPD
• South Hill Family Medicine PC

  • Family Medicine Physician
  • Puyallup, WA
  • NPI 1538253331
  Medicare reassignment NPD
• Circle Medical Care Group PA

  • Family Medicine Physician
  • Tampa, FL
  • NPI 1972358760

  WA

  Medicare reassignment NPD
• Multicare Health System

  • Community/Retail Pharmacy
  • Spokane, WA
  • NPI 1396594875
  NPD
• Multicare Health System

  • Pediatrics Physician
  • Tacoma, WA
  • NPI 1427601467
  NPD
• Cascade Eye & Skin Centers PC

  • Ophthalmology Physician
  • Auburn, WA
  • NPI 1427293109
  NPD (past)
• Multicare Health System

  • Family Medicine Physician
  • Auburn, WA
  • NPI 1013969195
  NPD (past)

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

• Multicare Health System

  • General Acute Care Hospital
  • Tacoma, WA
  • NPI 1366556227
  Care Compare affiliation

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

{
    "created_epoch": "1669766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669766400000",
    "number": "1558071597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10004 204TH AVE E FL 3",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983916539",
            "telephone_number": "253-848-5951",
            "fax_number": "253-845-7073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10004 204TH AVE E FL 3",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983916539",
            "telephone_number": "253-848-5951",
            "fax_number": "253-845-7073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "COURTNEY",
        "middle_name": "DYAN",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-30",
        "last_updated": "2022-11-30",
        "certification_date": "2022-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP61372574",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Annie Quach, RPH
• Rainier Biobehavioral Institute, LLC
• Rainier Biobehavioral Institute, LLC
• Archana Madhuri Rajan, M.D
• Shona Catherine Ramsay, MS, ATC, LAT
• Rediclinic of Wa, LLC
• Rehan Bashar DDS PLLC
• Van Reid, D.D.S
• Tammy Lee Remick, LMP
• Renal Care Group Northwest, Inc.

• Family Nurse Practitioner in Bonney Lake, WA
• Providers in Bonney Lake, WA by specialty
• Family Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.