Organization Active NPI

Alisa L Williams, MD, Facog, Inc.

  • Specialist
  • San Diego, CA
National Provider Identifier
1083887921
Registry record updated Jan 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
G60944 Issued in CA
Legal business name
ALISA L WILLIAMS, MD, FACOG, INC.
Practice address
5555 Reservoir Dr Ste 307
San Diego, CA 92120-5134
Phone
(619) 299-3111
Fax
(619) 299-3126
NPI assigned
Apr 11, 2008
Last updated
Jan 2, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2020

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

Authorized official

Name
Dr. Alisa Lynn Williams, M.D.
Title
Officer
Phone
(619) 299-3111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X G60944 CA Primary

Addresses

Primary practice location

5555 Reservoir Dr Ste 307
San Diego, CA 92120-5134

Mailing address

5555 Reservoir Dr Ste 307
San Diego, CA 92120-5134
Phone (619) 299-3111

Other identifiers 1

IdentifierTypeStateIssuer
000G609440MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090122000485 CA Part B Supplier - Clinic/Group Practice 1153222989 Receives reassigned benefits from 1 practitioner
Practice locations: San Diego, CA

National Provider Directory

National Provider Directory

Locations

5555 Reservoir Dr
Ste 307
San Diego, CA 92120
Phone (619) 299-3111

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1207872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577923200000",
    "number": "1083887921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5555 RESERVOIR DR STE 307",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921205134",
            "telephone_number": "619-299-3111",
            "fax_number": "619-299-3126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5555 RESERVOIR DR STE 307",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921205134",
            "telephone_number": "619-299-3111",
            "fax_number": "619-299-3126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALISA L WILLIAMS, MD, FACOG, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-11",
        "last_updated": "2020-01-02",
        "certification_date": "2020-01-02",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "ALISA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "619-299-3111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "G60944",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000G609440",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.