Individual provider Active NPI

Jessica Williams

  • Registered Dietitian
  • Philadelphia, PA
National Provider Identifier
1457095531
Registry record updated Jul 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
DN006190 Issued in PA
Practice address
10 Shurs LN
Philadelphia, PA 19127-2123
Phone
(215) 482-1234
Fax
(215) 482-0465
NPI assigned
Apr 25, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 14, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X DN006190 PA Primary

Addresses

Primary practice location

10 Shurs LN
Philadelphia, PA 19127-2123

Mailing address

3509 N Broad St
Philadelphia, PA 19140-4105
Phone (215) 707-3911

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE, PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240408000737 DE Practitioner - Registered Dietitian Or Nutrition Professional 1153718465 Reassigns benefits to 1 organization
I20260626000128 PA Practitioner - Registered Dietitian Or Nutrition Professional 1153718465 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
United Medical LLCGroup PAC ID 8325062144, 6 clinicians

Practice addresses (Care Compare)

121 Becks Wood Dr
Bear, DE 19701-3853
Phone (302) 365-8333

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN-0011159DEMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
United Medical, LLC CurrentSince Apr 11, 2024 Accepting new patients

Locations

121 Becks Woods Dr
Bear, DE 19701
Phone (302) 365-8333

121 Becks Woods Dr
Ste 100
Bear, DE 19701
Phone (302) 836-8200

800 Delaware Ave
Fl 5
Wilmington, DE 19801
Phone 3022669166454

600 Delaware Ave
Wilmington, DE 19801
Phone (302) 261-5600

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/d0607508-3922-4bbc-924a-d608b5ffe3b7/

Organizations & group practices 2

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": "1650844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783987200000",
    "number": "1457095531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3509 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191404105",
            "telephone_number": "215-707-3911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 SHURS LN",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191272123",
            "telephone_number": "215-482-1234",
            "fax_number": "215-482-0465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "JESSICA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-25",
        "last_updated": "2026-07-14",
        "certification_date": "2026-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "PA",
            "license": "DN006190",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2026; 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.