Charles D Randolph, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD61172546 Issued in WA

Practice address

411 Fortuyn Rd
Grand Coulee, WA 99133-8718

Phone

(509) 633-1911

Fax

(509) 633-3644

NPI assigned

May 30, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Loma Linda University School of Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Douglas, Grant, Lincoln and Okanogan Counties Public Hospital DistrictGroup PAC ID 9335050285, 40 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Coulee Medical Center Hospital, Grand Coulee, WA, CCN 501308
• Coulee Medical Center Nursing home, CCN 50Z308

Merit-based Incentive Payment System (MIPS)

Final score

93.78 of 100Reported as apm

Quality

80.38

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Douglas, Grant, Lincoln & Okanogan Counties Public Hospital District 6

  • Critical Access Hospital
  • Grand Coulee, WA
  • NPI 1184844185
  Medicare reassignment Care Compare group NPD
• Douglas, Grant, Lincoln & Okanogan Counties Public Hospital District 6

  • Family Medicine Physician
  • Grand Coulee, WA
  • NPI 1265422935
  NPD
• Douglas, Grant, Lincoln & Okanogan Counties Public Hospital District 6

  • Medicare Defined Swing Bed Hospital Unit
  • Grand Coulee, WA
  • NPI 1699851840
  NPD

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

• Douglas, Grant, Lincoln & Okanogan Counties Public Hospital District 6

  • Critical Access Hospital
  • Grand Coulee, WA
  • NPI 1184844185
  Care Compare affiliation
• Douglas, Grant, Lincoln & Okanogan Counties Public Hospital District 6

  • Medicare Defined Swing Bed Hospital Unit
  • Grand Coulee, WA
  • NPI 1699851840

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1559174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657152000000",
    "number": "1760040281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 FORTUYN RD",
            "city": "GRAND COULEE",
            "state": "WA",
            "postal_code": "991338718",
            "telephone_number": "509-633-1911",
            "fax_number": "509-633-3644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 FORTUYN RD",
            "city": "GRAND COULEE",
            "state": "WA",
            "postal_code": "991338718",
            "telephone_number": "509-633-1911",
            "fax_number": "509-633-3644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDOLPH",
        "first_name": "CHARLES",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-30",
        "last_updated": "2022-07-07",
        "certification_date": "2022-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD61172546",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2136043",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jason Pepperd, D.C.
• Gail A. Peterson, ARNP, FNP-BC
• Kelly J Prather, PT
• Rhonda Marie Ramm, ARNP
• Duane L Rana, OD
• Lawrence Robert Rehn, DDS
• Richard M King
• Karen Dawn Rimpler, ARNP
• Michael Lee Rimpler, CRNA
• Safeway Inc

• Family Medicine Physician in Grand Coulee, WA
• Providers in Grand Coulee, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 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.