Individual provider Active NPI

William Henry Taylor V, AGACNP-BC

  • Critical Care Medicine Nurse Practitioner
  • Marlton, NJ
National Provider Identifier
1053185256
Registry record updated Oct 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine Nurse PractitionerTaxonomy code 363LC0200X
License
26NJ15000900 Issued in NJ
Practice address
141 Route 70 E Ste B
Marlton, NJ 08053-1855
Phone
(856) 596-9057
NPI assigned
Nov 8, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine Registered Nurse 163WC0200X 26NR22665200 NJ
Critical Care Medicine Nurse Practitioner 363LC0200X 26NJ15000900 NJ Primary

Addresses

Primary practice location

141 Route 70 E Ste B
Marlton, NJ 08053-1855

Mailing address

301 Lippincott Dr Ste 410
Marlton, NJ 08053-4197
Phone (856) 355-0340

Other identifiers 1

IdentifierTypeStateIssuer
0986259MedicaidNJ

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address wtaylor265878@directvirtua.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240417000830 NJ Practitioner - Nurse Practitioner 8224477724 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Virtua Medical Group, PAGroup PAC ID 9830222397, 1,678 clinicians

Practice addresses (Care Compare)

141 Route 70 E
Suite B
Marlton, NJ 08053-1855
Phone (856) 596-9057

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
26NR22665200NJMDCritical Care Medicine Registered Nurse
26NJ15000900NJMDCritical Care Medicine Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Virtua Medical Group, PA CurrentSince Mar 11, 2024 Accepting new patients
Virtua Medical Group, PA CurrentSince Mar 11, 2024 Accepting new patients

Locations

3242 Route 206
Ste 2
Bordentown, NJ 08505
Phone (609) 298-4340

141 Route 70 E
Ste B
Marlton, NJ 08053
Phone (856) 596-9057

301 Lippincott Dr
Ste 410
Marlton, NJ 08053

303 Lippincott Dr
Ste 200
Marlton, NJ 08053
Phone (856) 355-0335

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1699401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1053185256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 LIPPINCOTT DR STE 410",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080534197",
            "telephone_number": "856-355-0340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 ROUTE 70 E STE B",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080531855",
            "telephone_number": "856-596-9057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAYLOR",
        "first_name": "WILLIAM",
        "middle_name": "HENRY",
        "name_suffix": "V",
        "credential": "AGACNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-11-08",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "NJ",
            "license": "26NR22665200",
            "primary": false
        },
        {
            "code": "363LC0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Critical Care Medicine",
            "state": "NJ",
            "license": "26NJ15000900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0986259",
            "state": "NJ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "wtaylor265878@directvirtua.org",
            "affiliation": "N",
            "address_1": "141 Route 70 E Ste B",
            "city": "Marlton",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080531855",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Marlton, NJ

Sources for this page

Verify at the official NPI Registry.