Active NPI
Jesse J. Williams, P.A.
- Surgical Physician Assistant
- Greenville, SC
National Provider Identifier
1275565848
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 1123
- Practice address
- 701 Grove Rd
Greenville, SC 29605-5611 - Phone
- (864) 455-7000
- NPI assigned
- Jul 6, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 1123 | SC | Primary |
Addresses
Primary practice location
701 Grove Rd
Greenville, SC 29605-5611
Mailing address
One Independence Pointe
Suite 212
Greenville, SC 29615-4566
Phone (864) 797-6044
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0438PA | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1123 | SC | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Greenville Health System | Past | Accepting new patients | |
| Premise Health of South Carolina Medical PC | Past | Accepting new patients |
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.
-
- Emergency Medicine Physician
- Myrtle Beach, SC
- NPI 1861430555
-
dba GHS Cardiovascular SVCS Simp
- General Acute Care Hospital
- Simpsonville, SC
- NPI 1679992838
-
dba Associate Family Health Center
- Multi-Specialty Clinic/Center
- Greer, SC
- NPI 1144577743
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1371772800000",
"number": "1275565848",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "ONE INDEPENDENCE POINTE",
"address_2": "SUITE 212",
"city": "GREENVILLE",
"state": "SC",
"postal_code": "296154566",
"telephone_number": "864-797-6044",
"fax_number": "864-797-6198"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 GROVE RD",
"city": "GREENVILLE",
"state": "SC",
"postal_code": "296055611",
"telephone_number": "864-455-7000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "JESSE",
"middle_name": "J.",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-06",
"last_updated": "2013-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "SC",
"license": "1123",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0438PA",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greenville, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.