NPIMap

Organization Active NPI

Randall Inc.

  • Preferred Provider Organization
  • Lynnwood, WA
National Provider Identifier
1992063945
Registry record updated Apr 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
2221 Issued in WA
Legal business name
RANDALL INC.
Practice address
19721 Scriber Lake Rd
#D
Lynnwood, WA 98036
Phone
(425) 775-3544
Fax
(425) 670-6502
NPI assigned
Apr 27, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2012

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

Authorized official

Name
Dr. Randall G Dreessen, DCNPI 1902838782
Title
Owner
Phone
(425) 775-3544

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X 2221 WA Primary

Addresses

Primary practice location

19721 Scriber Lake Rd
#D
Lynnwood, WA 98036

Mailing address

19721 Scriber Lake Rd Ste D
Lynnwood, WA 98036-6119
Phone (425) 775-3544

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120719000351 WA Part B Supplier - Clinic/Group Practice 0446416473 Receives reassigned benefits from 1 practitioner
Practice locations: Lynnwood, WA

National Provider Directory

National Provider Directory

Locations

19721 Scriber Lake Rd
Ste D
Lynnwood, WA 98036
Phone (425) 775-3544

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1335484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335484800000",
    "number": "1992063945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19721 SCRIBER LAKE RD STE D",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980366119",
            "telephone_number": "425-775-3544",
            "fax_number": "425-670-6502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19721 SCRIBER LAKE RD",
            "address_2": "#D",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "98036",
            "telephone_number": "425-775-3544",
            "fax_number": "425-670-6502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANDALL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-27",
        "last_updated": "2012-04-27",
        "status": "A",
        "authorized_official_last_name": "DREESSEN",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-775-3544",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "WA",
            "license": "2221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynnwood, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.