William Taylor Timberlake III, MD, MPH

Primary specialty

Aerospace Medicine PhysicianTaxonomy code 2083A0100X

License

0101256863 Issued in VA

Practice address

374TH Medical Group
Unit 5071
Apo, AP 96328-5071

Phone

(315) 225-7508

NPI assigned

Feb 17, 2013

Last updated

Oct 26, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• 21St Medgrp-Peterson

  dba DoD SCHRIEVER ePhcy

  • Military/U.S. Coast Guard Pharmacy
  • Schriever AFB, CO
  • NPI 1487069621
  NPD (past)

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

{
    "created_epoch": "1361059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698278400000",
    "number": "1346580081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "MIL",
            "address_1": "374TH MEDICAL GROUP",
            "address_2": "UNIT 5071",
            "city": "APO",
            "state": "AP",
            "postal_code": "96328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "MIL",
            "address_1": "374TH MEDICAL GROUP",
            "address_2": "UNIT 5071",
            "city": "APO",
            "state": "AP",
            "postal_code": "963285071",
            "telephone_number": "315-225-7508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIMBERLAKE",
        "first_name": "WILLIAM",
        "middle_name": "TAYLOR",
        "name_suffix": "III",
        "credential": "MD, MPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-02-17",
        "last_updated": "2023-10-26",
        "certification_date": "2023-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083A0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Aerospace Medicine",
            "state": "VA",
            "license": "0101256863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2023; 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.

Verify at the official NPI Registry.