Active NPI
Pevin Williams, CRNA
- Certified Registered Nurse Anesthetist
- Fayetteville, NC
National Provider Identifier
1457458523
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 149353
- Practice address
- 1638 Owen Dr
Fayetteville, NC 28304-3424 - Phone
- (910) 609-6440
- Fax
- (910) 609-5365
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 149353 | NC | Primary |
Addresses
Primary practice location
1638 Owen Dr
Fayetteville, NC 28304-3424
Mailing address
PO Box 40908
Fayetteville, NC 28309-0908
Phone (910) 609-6448
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8052601 | Medicaid | NC | |
| 193259 | Other | NC | MEDCOST |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC, SC
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1210 | NC | MD | Audiologist-Hearing Aid Fitter |
| 149353 | NC | MD | Certified Registered Nurse Anesthetist |
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.
-
- Endoscopy Clinic/Center
- Fayetteville, NC
- NPI 1912340944
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202947200000",
"number": "1457458523",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 40908",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283090908",
"telephone_number": "910-609-6448",
"fax_number": "910-609-7040"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1638 OWEN DR",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283043424",
"telephone_number": "910-609-6440",
"fax_number": "910-609-5365"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "PEVIN",
"name_prefix": "Mr.",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2008-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "NC",
"license": "149353",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8052601",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDCOST",
"identifier": "193259",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.