Individual provider Active NPI

Tiffani L Williams, PA-C

  • Physician Assistant
  • Morton, IL
National Provider Identifier
1447589650
Registry record updated Oct 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085-003619 Issued in IL
Practice address
435 Maxine Dr
Morton, IL 61550-2498
Phone
(309) 263-2424
Fax
(309) 284-2244
NPI assigned
Dec 17, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2019

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 085-003619 IL Primary

Addresses

Primary practice location

435 Maxine Dr
Morton, IL 61550-2498

Mailing address

435 Maxine Dr
Morton, IL 61550-2498
Phone (309) 263-2424

Other identifiers 4

IdentifierTypeStateIssuer
834340OtherILMEDICARE GROUP PTAN
834340025OtherILMEDICARE INDIVIDUAL PTAN
553180OtherILMEDICARE GROUP PTAN
553180037OtherILMEDICARE INDIVIDUAL PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100527000265 IL Practitioner - Physician Assistant 5294864328 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

1107 S Division Ave
Polo, IL 61064-1875
Phone (815) 946-3453

8600 State Route 91
Suite 130
Peoria, IL 61615-7829
Phone (309) 683-5050

Hospital & facility affiliations

  • Osf Saint Katharine Medical Center Hospital, Dixon, IL, CCN 140012

Merit-based Incentive Payment System (MIPS)

Final score
82.78 of 100Reported as group
Quality
60.49
Promoting interoperability
100
Improvement activities
40
Cost
77.11

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085-003619ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
KSB Medical Group, Inc. CurrentSince Jun 8, 2020 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
KSB Medical Group, Inc. CurrentSince Jun 8, 2020 Accepting new patients

Locations

215 E 1st St
Ste 111
Dixon, IL 61021
Phone (815) 285-5477

215 E 1st St
Ste 117
Dixon, IL 61021
Phone (815) 285-5900

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

1107 S Division Ave
Polo, IL 61064
Phone (815) 946-3453

Organizations & group practices 4

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": "1261008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571788800000",
    "number": "1447589650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "435 MAXINE DR",
            "city": "MORTON",
            "state": "IL",
            "postal_code": "615502498",
            "telephone_number": "309-263-2424",
            "fax_number": "309-284-2244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 MAXINE DR",
            "city": "MORTON",
            "state": "IL",
            "postal_code": "615502498",
            "telephone_number": "309-263-2424",
            "fax_number": "309-284-2244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "TIFFANI",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-12-17",
        "last_updated": "2019-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-003619",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "834340",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE INDIVIDUAL PTAN",
            "identifier": "834340025",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "553180",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE INDIVIDUAL PTAN",
            "identifier": "553180037",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Morton, IL

Sources for this page

Verify at the official NPI Registry.