DR. RANDEE LYNE NICHOLAS (D.O.) – Family Medicine Physician, NPI 1033134069
Family Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for DR. RANDEE LYNE NICHOLAS (D.O.)
2200 BERGQUIST DR STE 1
ATTN: CREDENTIALS CMC LACKLAND AFB
LACKLAND A F B, TX 782369908
Phone: (210) 945-7177
Type: Mailing
1100 WILFORD HALL LOOP BLDG 4554
LACKLAND AFB, TX 78236
Phone: (210) 292-3016
Type: Location
5100 E BROADWAY BLVD
TUCSON, AZ 857113762
Phone: (210) 787-6442
Fax: (000) 000-0000
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
Loading prescription activity...
Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $35.
Total Amount is formed as General ($35) + Research ($0) + Ownership ($0) = $35.
Last reported payment date: 2023-10-10 • Largest payer in this snapshot: Boston Scientific Corporation ($35).
Total Amount
$35
General + Research + Ownership
Payments
1
Total payment records
General Amount
$35
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-10-10
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Boston Scientific Corporation | $35 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2023-08-04
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20230804000447 | I | Family Practice | NH | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 78236)
Loading plans...
Reviews
All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.
No reviews yet. Be the first to share your experience — your opinion helps families compare providers.