Individual provider Active NPI

Michael C Williams, MD

  • Emergency Medicine Physician
  • Fort Walton Beach, FL
National Provider Identifier
1023066776
Registry record updated Apr 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
ME85517 Issued in FL
Practice address
1000 Mar Walt Dr
Fort Walton Beach, FL 32547-6708
Phone
(850) 863-7607
Fax
(205) 437-5998
NPI assigned
May 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X ME85517 FL Primary

Addresses

Primary practice location

1000 Mar Walt Dr
Fort Walton Beach, FL 32547-6708

Mailing address

PO Box 88452
Chicago, IL 60680-1452
Phone (205) 437-6098

Other identifiers 4

IdentifierTypeStateIssuer
059190007OtherALBCBS PROVIDER NUMBER
059189774OtherALBCBS PROVIDER NUMBER
265505500MedicaidFL
62835OtherFLBCBS PROVIDER NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031205000195 FL Practitioner - Emergency Medicine 3072418698 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Medicine Services of FL, LLC Emergency Medicine CurrentSince Apr 1, 2023 Accepting new patients
West Florida Radiology Associates PA Past Accepting new patients

Locations

322 SW Pine Island Rd
Cape Coral, FL 33991
Phone (941) 249-6858

200 Tequesta Dr
Destin, FL 32541
Phone (850) 837-9194

1000 Mar Walt Dr
Ft Walton Bch, FL 32547
Phone (850) 374-9610

14000 Fivay Rd
Hudson, FL 34667
Phone (727) 819-2929

20900 Biscayne Blvd
Miami, FL 33180
Phone (305) 682-7290

1809 Granada St
Navarre, FL 32566
Phone (850) 684-6200

105 Tamiami Trl
Fl Tamiami
Port Charlotte, FL 33953

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1240444800000",
    "number": "1023066776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 88452",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606801452",
            "telephone_number": "205-437-6098",
            "fax_number": "205-437-5998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 MAR WALT DR",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476708",
            "telephone_number": "850-863-7607",
            "fax_number": "205-437-5998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "MICHAEL",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-05",
        "last_updated": "2009-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "ME85517",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "059190007",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "059189774",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "265505500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "62835",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Walton Beach, FL

Sources for this page

Verify at the official NPI Registry.