Harold Herman Randecker Jr., MD

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

14276 Issued in WA

Practice address

1814 90TH Dr SE
Lake Stevens, WA 98258-3791

Phone

(425) 829-0700

Fax

(253) 216-3635

NPI assigned

Apr 24, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Pacific Vascular Incorporated

  • Physiological Laboratory
  • Port Ludlow, WA
  • NPI 1336019314
  NPD (past)

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1310083200000",
    "number": "1891914370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1814 90TH DR SE",
            "city": "LAKE STEVENS",
            "state": "WA",
            "postal_code": "982583791",
            "telephone_number": "425-829-0700",
            "fax_number": "253-216-3635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1814 90TH DR SE",
            "city": "LAKE STEVENS",
            "state": "WA",
            "postal_code": "982583791",
            "telephone_number": "425-829-0700",
            "fax_number": "253-216-3635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDECKER",
        "first_name": "HAROLD",
        "middle_name": "HERMAN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-24",
        "last_updated": "2011-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "WA",
            "license": "14276",
            "primary": true
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "WA",
            "license": "14276",
            "primary": false
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "WA",
            "license": "14276",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WA",
            "license": "14276",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pine Tree Psychotherapy PLLC
• Ryan Price
• PSPD - Lake Stevens PLLC
• Pamela Perez Quezada-Grupo, NAC
• Lydia Iris Ramirez
• Suanne Reynolds, RPH
• Ronald L Rhea, LMP
• Christinna L Rieken, BCBA, LBA
• Richella Riley, DPT
• Cynthia Robson, LISW

• Vascular Surgery Physician in Lake Stevens, WA
• Providers in Lake Stevens, WA by specialty
• Vascular Surgery Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.