NPIMap

Individual provider Active NPI

Mitchell Williams, PA-C

  • Physician Assistant
  • Moore, OK
National Provider Identifier
1295241339
Registry record updated Dec 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2845 Issued in OK
Practice address
2109 S Santa Fe Ave
Moore, OK 73160-2807
Phone
(405) 213-0256
NPI assigned
Dec 27, 2017
Last updated
Dec 27, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2845 OK Primary

Addresses

Primary practice location

2109 S Santa Fe Ave
Moore, OK 73160-2807

Mailing address

11507 Keystone Cir
Oklahoma City, OK 73114-7649

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20180221001508 OK Practitioner - Physician Assistant 1153682802 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oklahoma City Orthopedics and Sports Medicine PLLCGroup PAC ID 0345209326, 3 clinicians

Practice addresses (Care Compare)

1015 SW 4TH St
Moore, OK 73160-2404
Phone (405) 418-4500

13100 N Western Ave
Suite 200
Oklahoma City, OK 73114-1431
Phone (405) 418-4500

1650 Main St
Woodward, OK 73801-3046
Phone (405) 418-4500

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Jackson County Memorial Hospital Authority Past Accepting new patients
Summit Medical Center Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: mitchell.williams.1@17619.direct.athenahealth.com
  • Direct secure messaging: mitchell.williamspac.p1@direct.okc.nextgenshare.com

Organizations & group practices 5

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 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": "1514332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1514332800000",
    "number": "1295241339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11507 KEYSTONE CIR",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731147649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2109 S SANTA FE AVE",
            "city": "MOORE",
            "state": "OK",
            "postal_code": "731602807",
            "telephone_number": "405-213-0256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "MITCHELL",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-12-27",
        "last_updated": "2017-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "2845",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moore, OK

Sources for this page

Verify at the official NPI Registry.