NPIMap

Individual provider Active NPI

Evan Grant Williams, M.D.

  • Hospitalist Physician
  • Farmington, MO
National Provider Identifier
1174605620
Registry record updated Mar 31, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
2019009758 Issued in MO
Practice address
1101 W Liberty St
Farmington, MO 63640-1921
Phone
(573) 756-6751
NPI assigned
Oct 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 28008 SC
Pediatrics Physician 208000000X 28008 SC
Hospitalist Physician 208M00000X 28008 SC
Hospitalist Physician 208M00000X 2019009758 MO Primary

Addresses

Primary practice location

1101 W Liberty St
Farmington, MO 63640-1921

Mailing address

1101 W Liberty St
Farmington, MO 63640-1921
Phone (573) 756-6751

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20100302000837 MO Practitioner - HospitalistPractitioner - Internal Medicine 2961547997 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
University of Missouri, Columbia School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physician Groups LCGroup PAC ID 3072421254, 526 clinicians

Practice addresses (Care Compare)

1101 W Liberty St
Farmington, MO 63640-1921
Phone (573) 756-6751

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
28008SCMDInternal Medicine Physician
2019009758MOMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Groups LC CurrentSince Jun 23, 2020 Accepting new patients
Physician Groups LC Internal Medicine CurrentSince Jun 23, 2020 Accepting new patients
Parkland Health Center Past Accepting new patients

Locations

1101 W Liberty St
Farmington, MO 63640
Phone (573) 705-1272

2630 Highway K
O Fallon, MO 63368
Phone (636) 240-5454

Interoperability endpoints

  • FHIR API: https://pmh-vmhaiku-01.pmh.org/FHIR/PARKLAND/api/FHIR/R4
  • FHIR API: https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/R4/
  • FHIR API: https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Organizations & group practices 3

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 5

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": "1161302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617148800000",
    "number": "1174605620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 W LIBERTY ST",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636401921",
            "telephone_number": "573-756-6751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 W LIBERTY ST",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636401921",
            "telephone_number": "573-756-6751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "EVAN",
        "middle_name": "GRANT",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-20",
        "last_updated": "2021-03-31",
        "certification_date": "2021-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "28008",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "28008",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "SC",
            "license": "28008",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MO",
            "license": "2019009758",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1101 W Liberty St",
            "city": "Farmington",
            "state": "MO",
            "country_code": "US",
            "postal_code": "636401921",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Farmington, MO

Sources for this page

Verify at the official NPI Registry.