NPIMap

Individual provider Active NPI

David W. Williams, PA

  • Physician Assistant
  • St Augustine, FL
National Provider Identifier
1457523011
Registry record updated Dec 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA3576 Issued in FL
Practice address
400 Health Park Blvd
St Augustine, FL 32086-5784
Phone
(904) 819-4300
NPI assigned
Mar 24, 2008
Last updated
Dec 21, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2015

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 PA3576 FL Primary

Addresses

Primary practice location

400 Health Park Blvd
St Augustine, FL 32086-5784

Mailing address

100 Arricola Ave
Saint Augustine, FL 32080-4515
Phone (904) 797-7740

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20080812000747 FL Practitioner - Physician Assistant 5294800140 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of North Dakota School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

100 Arricola Ave
Saint Augustine, FL 32080-4515

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
003111GAMDPediatric Occupational Therapist
PA3576FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Emcare Physician Providers, Inc. Past Accepting new patients
Augustine Emergency Physicians LLC Past Accepting new patients
Emcare Physician Providers, Inc. Past Accepting new patients
Emergency Physicians of St. Johns County Past Accepting new patients
Florida Em-I Medical Services PA Past Accepting new patients

Organizations & group practices 6

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": "1206316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450656000000",
    "number": "1457523011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 ARRICOLA AVE",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320804515",
            "telephone_number": "904-797-7740",
            "fax_number": "904-797-7417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 HEALTH PARK BLVD",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320865784",
            "telephone_number": "904-819-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "DAVID",
        "middle_name": "W.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-24",
        "last_updated": "2015-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA3576",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

Verify at the official NPI Registry.