Individual provider Active NPI

Schulundria Schantelle Williams

  • Certified Registered Nurse Anesthetist
  • Tyler, TX
National Provider Identifier
1205821055
Registry record updated Dec 18, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
642834 Issued in TX
Practice address
800 E Dawson St
Tyler, TX 75701-2036
Phone
(903) 593-8441
NPI assigned
Sep 19, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 642834 TX Primary

Addresses

Primary practice location

800 E Dawson St
Tyler, TX 75701-2036

Mailing address

2323 Pineburr Rd
Tyler, TX 75702-7733
Phone (903) 592-1825

Other identifiers 4

IdentifierTypeStateIssuer
75-1976930-005OtherTXTRICARE
366204YSE3OtherTXMEDICARE
174283506MedicaidTX
P01912522OtherTXMEDICARE RAIL ROAD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040722000633 TX Practitioner - Certified Registered Nurse Anesthetist (Crna) 6901889021 Reassigns benefits to 4 organizations
Practice locations: Tyler, TX

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

800 E Dawson St
Christus Mother Frances Hospital
Tyler, TX 75701-2036
Phone (903) 561-5018

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
642834TXMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
University of Texas Health Science Center at Tyler-Facility-Physician Current Accepting new patients
University of Texas Health Science Center at Tyler-Facilty-Physician CurrentSince Mar 2, 2005 Accepting new patients
Christus Trinity Clinic Texas Current Accepting new patients
Christus Good Shepherd Medical Center CurrentSince Sep 1, 2017 Accepting new patients
Mother Frances Hospital Regional Health Care Center CurrentSince Mar 1, 2004 Accepting new patients
Christus Good Shepherd Medical Center Nurse Anesthetist, Certified Registered CurrentSince Sep 1, 2017 Accepting new patients
Mother Frances Hospital Jacksonville Nurse Anesthetist, Certified Registered CurrentSince Aug 2, 2017 Accepting new patients
University of Texas Health Science Center at Tyler Nurse Anesthetist, Certified Registered CurrentSince Mar 2, 2005 Accepting new patients
Mother Frances Hospital Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

2026 S Jackson St
Jacksonville, TX 75766
Phone (903) 541-4500

700 E Marshall Ave
Longview, TX 75601
Phone (903) 236-2000

102 W Henderson St
Overton, TX 75684
Phone (903) 834-0201

3200 Troup Hwy
Ste 200
Tyler, TX 75701
Phone (903) 533-8084

800 E Dawson St
Tyler, TX 75701
Phone (903) 531-5018

11937 US Highway 271
Tyler, TX 75708
Phone (903) 877-3451

Organizations & group practices 9

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 1

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": "1127088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513555200000",
    "number": "1205821055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2323 PINEBURR RD",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757027733",
            "telephone_number": "903-592-1825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 E DAWSON ST",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012036",
            "telephone_number": "903-593-8441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "SCHULUNDRIA",
        "middle_name": "SCHANTELLE",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-19",
        "last_updated": "2017-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "642834",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-1976930-005",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "366204YSE3",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "174283506",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAIL ROAD",
            "identifier": "P01912522",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.