Theodore J Williams, M.D.
Individual provider Active NPI Family Medicine Physician · Stanley, KS
NPI 1114914546 · NPPES record last updated Dec 31, 2012
Key facts
- NPI
- 1114914546
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 0422094 (KS)
- Practice address
- 15101 Glenwood Ave
Stanley, KS 66223-3154 - Phone
- (913) 681-8866
- Fax
- (913) 338-1311
- NPI assigned
- Sep 30, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of Kansas School of Med (KC/Wich/Sal), 1984
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mid America Pain Clinic LLC
Practice addresses (Care Compare)
7100 College Blvd
Overland Park, KS 66210-1862
Phone (913) 914-1234
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100630000361 | KS | Practitioner - Family Practice |
7012098288 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mid America Pain Clinic LLC | Current |
Accepting new patients | |
| College Park Family Care Center PA | Family Medicine | Current | Accepting new patients |
| College Park Family Care Center, P.a. | Past | Accepting new patients | |
| The Covenant Group PA | Past | Accepting new patients |
Locations
20333 W 151st St
Olathe, KS 66061
Phone (888) 960-1393
11755 W 112th St
Ste 101
Overland Park, KS 66210
Phone (913) 469-0503
7100 College Blvd
Overland Park, KS 66210
Phone (913) 599-2440
10550 Quivira Rd
Ste 360
Overland Park, KS 66215
Phone (913) 227-0565
10500 Quivira Rd
Shawnee Mission, KS 66215
Phone (913) 227-0565
15101 Glenwood Ave
Stanley, KS 66223
Phone (913) 681-4934
Interoperability endpoints
- theodore.williams@3858.securemail.prognocis.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 0422094 | KS | Yes |
Addresses
Primary practice location
15101 Glenwood Ave
Stanley, KS 66223-3154
Mailing address
PO Box 741331
Atlanta, GA 30374-1331
Phone (913) 469-0503
Other providers in Stanley, KS
- Brooke Nicole McGuire
- Annalee Neds
- Overland Park Surgical Specialties, LLC
- Robert L Schuchardt
- Suzanne H Shaffer
- Mary E Willis
All providers in Stanley, KS · Family Medicine Physician in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 31, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.