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MR. RANDALL C DICKSON PAC
NPI 1215960372
Physician Assistant - Medical in Everett, WA

Active since July 09, 2006PECOS Enrolled
1001 NORTH BROADWAY, SUITE A11, EVERETT, WA 98201(360) 658-4339(360) 658-9868 Get Directions Write a Review

NPPES record last updated: March 30, 2021. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Mr. Randall C Dickson Pac NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. RANDALL C DICKSON PAC (NPI 1215960372) is an individual medical provider in Everett, Washington, licensed in Washington (PA10003610) and active in the NPI registry since July 2006. He is enrolled in Medicare PECOS and maintains a secondary practice location in Renton.

NPPES Registry Identity

NPI1215960372
Entity TypeIndividualMale
Primary Taxonomy363AM0700X
Provider Legal NameMR. RANDALL C DICKSONCredential: PAC
Location Address1001 NORTH BROADWAY, SUITE A11Everett, WA 98201
Mailing Address2000 1st Ave, Unit 1001Seattle, WA 98121-2165 · (206) 420-8115
Phone(360) 658-4339
Fax(360) 658-9868
Sole ProprietorNo
Enumeration DateJuly 9, 2006
Last NPPES UpdateMarch 30, 2021
NPPES CertifiedMarch 30, 2021
✔ NPI 1215960372 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
License✔ Licensed in WA · PA10003610
Also ListedPhysician Assistant · SurgicalTaxonomy 363AS0400X · License PA10003610 (WA)
1001 NORTH BROADWAY, Everett, WA 98201
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Secondary Practice Location 1

Location 12921 Naches Ave SWRenton, WA 98057-2617 · Phone (206) 630-1350

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Randall C Dickson Pac is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Randall Dickson's NPI number?

The NPI number for Randall Dickson is 1215960372. It was assigned to this individual provider in the NPPES registry on July 9, 2006.

Where is Randall Dickson located?

Randall Dickson practices at 1001 North Broadway Suite A11, Everett, WA 98201. The listed phone number is (360) 658-4339.

What is Randall Dickson's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Randall Dickson enrolled in Medicare?

Yes. Randall Dickson is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Randall Dickson was last updated on March 30, 2021. NPI Profile syncs with the weekly NPPES data releases published by CMS.