NPIMap

Individual provider Active NPI

Andrew Fox Williams, MD

  • Internal Medicine Physician
  • Canton, NY
National Provider Identifier
1154365286
Registry record updated Dec 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
234927 Issued in NY
Practice address
4 Commerce Lane
Canton, NY 13617
Phone
(315) 386-8191
Fax
(315) 386-1410
NPI assigned
Jun 16, 2006
Last updated
Dec 2, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2011

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 2349271 NY
Internal Medicine Physician 207R00000X 234927 NY Primary

Addresses

Primary practice location

4 Commerce Lane
Canton, NY 13617

Mailing address

4 Commerce Lane
Canton, NY 13617
Phone (315) 386-8191

Other identifiers 1

IdentifierTypeStateIssuer
01995615MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20050912000171 NY Practitioner - Internal Medicine 5294768297 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Rochester School of Medicine and Dentistry, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4 Commerce LN
Canton, NY 13617-3739
Phone (315) 386-8191

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
234927NYMDInternal Medicine Physician
2349271NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
United Cerebral Palsy Association of the North Country, Inc. CurrentSince Jul 14, 2008 Accepting new patients
Edward John Noble Hospital of Gouverneur Ny Swing Bed Unit PastSince Feb 20, 2013 Accepting new patients

Locations

4 Commerce Ln
Canton, NY 13617
Phone (315) 386-1156

Ownership & related parties

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
Gouverneur HospitalGouverneur, NY, CCN 331315 Hospital Corporate Director Dec 16, 2013
Gouverneur HospitalGouverneur, NY, CCN 33Z315 Hospital Corporate Director Jan 1, 2014
Community Health Center of the North CountryGouverneur, NY, CCN 331085 Federally qualified health center Corporate Officer Jul 1, 2008
Community Health Center of the North CountryOgdensburg, NY, CCN 571195 Federally qualified health center Corporate Officer Jul 1, 2008
Gouverneur HospitalDe Kalb JCT, NY, CCN 333978 Rural health clinic Corporate Director Jan 1, 2014
Edwards Health Center, Gouverneur HospitalEdwards, NY, CCN 333979 Rural health clinic Corporate Director Jan 1, 2014

Owned or controlled facilities with NPI records 3

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322784000000",
    "number": "1154365286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 COMMERCE LANE",
            "city": "CANTON",
            "state": "NY",
            "postal_code": "13617",
            "telephone_number": "315-386-8191",
            "fax_number": "315-386-1410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 COMMERCE LANE",
            "city": "CANTON",
            "state": "NY",
            "postal_code": "13617",
            "telephone_number": "315-386-8191",
            "fax_number": "315-386-1410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "ANDREW",
        "middle_name": "FOX",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2011-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "2349271",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "234927",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01995615",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, NY

Sources for this page

Verify at the official NPI Registry.