NPIMap

Individual provider Active NPI

Candyce Williams, MD

  • Rehabilitation Practitioner
  • Phoenix, AZ
National Provider Identifier
1114991155
Registry record updated Jun 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation PractitionerTaxonomy code 225400000X
License
21064 Issued in AZ
Practice address
444 W Osborn Rd Ste 200
Phoenix, AZ 85013-3817
Phone
(602) 806-7610
Fax
(602) 704-6054
NPI assigned
Feb 15, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 10, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 21064 AZ
Rehabilitation Practitioner 225400000X 21064 AZ Primary

Addresses

Primary practice location

444 W Osborn Rd Ste 200
Phoenix, AZ 85013-3817

Mailing address

PO Box 15667
Phoenix, AZ 85060-5667
Phone (602) 806-7610

Other identifiers 1

IdentifierTypeStateIssuer
117467MedicaidAZ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050928000987 AZ Practitioner - Physical Medicine and Rehabilitation 4880629880 Practice locations: Phoenix, AZ

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Tufts University School of Medicine, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

444 W Osborn Rd
Suite 200
Phoenix, AZ 85013-3817
Phone (602) 806-7610

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
21064AZMDRehabilitation Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Candyce Williams MD, P L C CurrentSince Dec 16, 2020 Accepting new patients
Professional Diagnostix Past Accepting new patients
Arizona Cardiology Group PC Past Accepting new patients
Phoenix Spine Goodyear ASC, LLC Past Accepting new patients
Phoenix Spine Goodyear ASC, LLC PastSince Apr 18, 2003 Accepting new patients

Locations

444 W Osborn Rd
Ste 200
Phoenix, AZ 85013
Phone (602) 230-1400

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/22679/brand/1/csg/1/fhir/r4
  • Direct secure messaging: candyce.williams.1@22679.direct.athenahealth.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Center at Arrowhead LLCGlendale, AZ, CCN 035289 Skilled nursing facility Corporate Director (20%) Feb 2, 2015

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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 6

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": "1139961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623283200000",
    "number": "1114991155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15667",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850605667",
            "telephone_number": "602-806-7610",
            "fax_number": "602-704-6054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "444 W OSBORN RD STE 200",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850133817",
            "telephone_number": "602-806-7610",
            "fax_number": "602-704-6054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "CANDYCE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-02-15",
        "last_updated": "2021-06-10",
        "certification_date": "2021-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "21064",
            "primary": false
        },
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": "AZ",
            "license": "21064",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "117467",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.