Courtney Dyan Randolph, ARNP - Medicare Nurse Practitioner in Bonney Lake, WA

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Courtney Dyan Randolph, ARNP is a medicare enrolled "Nurse Practitioner - Family" in Bonney Lake, Washington. Her current practice location is 10004 204th Ave E Fl 3, Bonney Lake, Washington. You can reach out to her office (for appointments etc.) via phone at (253) 848-5951.

Courtney Dyan Randolph is licensed to practice in Washington (license number AP61372574) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1558071597.

Contact Information

Courtney Dyan Randolph, ARNP
10004 204th Ave E Fl 3,
Bonney Lake, WA 98391-6539
(253) 848-5951
(253) 845-7073

Map and Direction




Provider's Profile

Full NameCourtney Dyan Randolph
GenderFemale
SpecialityNurse Practitioner - Family
Location10004 204th Ave E Fl 3, Bonney Lake, Washington
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1558071597
  • Provider Enumeration Date: 11/30/2022
  • Last Update Date: 11/30/2022
  Medicare PECOS Information:
  • PECOS PAC ID: 1759741713
  • Enrollment ID: I20230721002361

Medical Identifiers

Medical identifiers for Courtney Dyan Randolph such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1558071597NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363LF0000XNurse Practitioner - Family AP61372574 (Washington)Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Courtney Dyan Randolph allows following entities to bill medicare on her behalf.
Entity NameSouth Hill Family Medicine Pc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1538253331
PECOS PAC ID: 8729980396
Enrollment ID: O20040123000443

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Courtney Dyan Randolph is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Courtney Dyan Randolph, ARNP
10004 204th Ave E Fl 3,
Bonney Lake, WA 98391-6539

Ph: (253) 848-5951		Courtney Dyan Randolph, ARNP
10004 204th Ave E Fl 3,
Bonney Lake, WA 98391-6539

Ph: (253) 848-5951

Reviews and Comments


Nurse Practitioner Nurses in Bonney Lake, WA

Rachel Lee Criddle, MSN, NP-C, ARNP
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: 9230 Sky Island Dr E, Bonney Lake, WA 98391
Phone: 253-750-6000    Fax: 253-750-6100
Kiersti Devaney, ARNP
Nurse Practitioner
Medicare: Medicare Enrolled
Practice Location: 10004 204th Ave E, Bonney Lake, WA 98391
Phone: 253-848-5951    Fax: 253-845-7073
Megan Barker,
Nurse Practitioner
Medicare: Medicare Enrolled
Practice Location: 9230 Sky Island Dr E, Bonney Lake, WA 98391
Phone: 253-750-6000    
Mr. Timothy Fletcher-velasco, FNP
Nurse Practitioner
Medicare: Not Enrolled in Medicare
Practice Location: 19647 Wa-410, Bonney Lake, WA 98391
Phone: 253-921-4569    Fax: 253-750-3475
Michelle Christine Jackson, ARNP
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: 9550 195th Ave E, Bonney Lake, WA 98391
Phone: 253-447-3400    
Maria Beloit, ARNP, FNP-C
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: 9230 Sky Island Dr E Fl 2, Bonney Lake, WA 98391
Phone: 253-750-6000    
Mrs. Teresa Ann Marshall, ARNP
Nurse Practitioner
Medicare: Accepting Medicare Assignments
Practice Location: 10004 204th Ave E, #3400, Bonney Lake, WA 98391
Phone: 253-848-5951    Fax: 253-845-7073

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.