Individual provider Active NPI

Damon Anthony William, DPT

  • Physical Therapist
  • Oklahoma City, OK
National Provider Identifier
1285166249
Registry record updated Jul 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
4213 Issued in OK
Practice address
5025 Gaillardia Corporate PL
Oklahoma City, OK 73142-1888
Phone
(405) 314-7137
NPI assigned
Mar 29, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 14, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 4213 OK Primary

Addresses

Primary practice location

5025 Gaillardia Corporate PL
Oklahoma City, OK 73142-1888

Mailing address

1229 NW 104TH Ter
Oklahoma City, OK 73114-5103
Phone (617) 804-2040

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220707000623 OK Practitioner - Physical Therapist in Private Practice 6204165731 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Synergy Care Southeast LLCGroup PAC ID 6204079163, 193 clinicians

Practice addresses (Care Compare)

Edmond, OK 73013
Phone (954) 591-1797

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4213OKMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Select Physical Therapy Holdings Inc Past Accepting new patients
Select Physical Therapy Holdings Inc PastSince Jul 10, 2022 Accepting new patients

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1490745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657756800000",
    "number": "1285166249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1229 NW 104TH TER",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731145103",
            "telephone_number": "617-804-2040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5025 GAILLARDIA CORPORATE PL",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731421888",
            "telephone_number": "405-314-7137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAM",
        "first_name": "DAMON",
        "middle_name": "ANTHONY",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-03-29",
        "last_updated": "2022-07-14",
        "certification_date": "2022-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OK",
            "license": "4213",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2022; 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.