Jerry D Williams II, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

902114 Issued in MS

Practice address

130 W Van Dorn Ave
Holly Springs, MS 38635-2902

Phone

(662) 274-3212

Fax

(662) 274-3213

NPI assigned

Jul 11, 2017

Last updated

Jul 17, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

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

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Holly Springs Family Medical, LLCGroup PAC ID 2668848581, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baptist Memorial Hospital Desoto Hospital, Southaven, MS, CCN 250141
• Methodist Healthcare - Olive Branch Hospital Hospital, Olive Branch, MS, CCN 250167
• Baptist Memorial Hospital Hospital, Memphis, TN, CCN 440048

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/
• Direct secure messaging: j.williams@hsfm-ms.direct.office.nextgen.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Holly Springs Family Medical LLC

  • Family Nurse Practitioner
  • Holly Springs, MS
  • NPI 1518692342
  Medicare reassignment Care Compare group NPD Authorized official

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

• Baptist Memorial Hospital-Desoto, Inc,

  • General Acute Care Hospital
  • Southaven, MS
  • NPI 1194789818
  Care Compare affiliation
• Methodist Healthcare - Olive Branch Hospital

  • General Acute Care Hospital
  • Olive Branch, MS
  • NPI 1912341439
  Care Compare affiliation
• Baptist Memorial Hospital

  • General Acute Care Hospital
  • Memphis, TN
  • NPI 1578527172
  Care Compare affiliation

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

{
    "created_epoch": "1499731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658016000000",
    "number": "1073035168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 W VAN DORN AVE",
            "city": "HOLLY SPRINGS",
            "state": "MS",
            "postal_code": "386352902",
            "telephone_number": "662-274-3212",
            "fax_number": "662-274-3213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 W VAN DORN AVE",
            "city": "HOLLY SPRINGS",
            "state": "MS",
            "postal_code": "386352902",
            "telephone_number": "662-274-3212",
            "fax_number": "662-274-3213"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "340 Stateline Rd W",
            "address_purpose": "LOCATION",
            "city": "Southaven",
            "state": "MS",
            "postal_code": "38671",
            "country_code": "US",
            "telephone_number": "662-579-3955",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "812B Newman Dr",
            "address_purpose": "LOCATION",
            "city": "Helena",
            "state": "AR",
            "postal_code": "72342",
            "country_code": "US",
            "telephone_number": "870-338-8312",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "130 W Van Dorn Ave",
            "address_purpose": "LOCATION",
            "city": "Holly Springs",
            "state": "MS",
            "postal_code": "386352902",
            "country_code": "US",
            "telephone_number": "662-274-3212",
            "fax_number": "662-274-3213",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "JERRY",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-11",
        "last_updated": "2022-07-17",
        "certification_date": "2022-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "A005207",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "902114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Holly Springs, MS
• Providers in Holly Springs, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.