Individual provider Active NPI

Tiffany Williams, DNP

  • Family Nurse Practitioner
  • Fairchild AFB, WA
National Provider Identifier
1457709792
Registry record updated Oct 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
811981 Issued in NV
Practice address
92 MDG
701 Hospital Loop Ste 350
Fairchild AFB, WA 99011
Phone
(509) 247-5888
NPI assigned
May 26, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APRN.CNP.0036079 OH
Student in an Organized Health Care Education/Training Program 390200000X
Family Nurse Practitioner 363LF0000X 811981 NV Primary

Addresses

Primary practice location

92 MDG
701 Hospital Loop Ste 350
Fairchild AFB, WA 99011

Mailing address

701 Hospital Loop Ste 350
Fairchild AFB, WA 99011-8704
Phone (509) 247-5888

Other practice location 1

4301 Jones Bridge Rd
Bethesda, MD 20814-4712
Phone (301) 295-9561

Other practice location 2

1989 Miamisburg Centerville Rd Ste 201
Dayton, OH 45459-3858
Phone (937) 401-7575

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/
Direct Messaging Address twilliams640881@direct.ketteringhealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20240823002811 OH Practitioner - Nurse Practitioner 4486904760 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kettering Independent Medical Group IncGroup PAC ID 3173710936, 699 clinicians

Practice addresses (Care Compare)

1989 Miamisburg Centerville Rd
Suite 201
Centerville, OH 45459-3858
Phone (937) 401-7550

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.34 of 100Reported as group
Quality
63.67
Promoting interoperability
100
Improvement activities
40
Cost
74.14

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Kettering Independent Medical Group Inc CurrentSince Jun 30, 2024 Accepting new patients

Locations

2510 Commons Blvd
Ste 160
Beavercreek, OH 45431
Phone (937) 425-4010

1989 Miamisburg Centerville Rd
Ste 201
Dayton, OH 45459
Phone (937) 401-7575

4403 Far Hills Ave
Kettering, OH 45429
Phone (937) 395-3910

2115 Leiter Rd
Miamisburg, OH 45342
Phone (937) 384-6920

1 Prestige Pl
Ste 550
Miamisburg, OH 45342
Phone (937) 752-2306

Organizations & group practices 1

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 2

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": "1464220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730246400000",
    "number": "1457709792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 HOSPITAL LOOP STE 350",
            "city": "FAIRCHILD AFB",
            "state": "WA",
            "postal_code": "990118704",
            "telephone_number": "509-247-5888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "92 MDG",
            "address_2": "701 HOSPITAL LOOP STE 350",
            "city": "FAIRCHILD AFB",
            "state": "WA",
            "postal_code": "99011",
            "telephone_number": "509-247-5888"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4301 Jones Bridge Rd",
            "address_purpose": "LOCATION",
            "city": "Bethesda",
            "state": "MD",
            "postal_code": "208144712",
            "country_code": "US",
            "telephone_number": "301-295-9561",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1989 Miamisburg Centerville Rd Ste 201",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454593858",
            "country_code": "US",
            "telephone_number": "937-401-7575",
            "fax_number": "937-522-8350",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "TIFFANY",
        "name_prefix": "Dr.",
        "credential": "DNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-26",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "APRN.CNP.0036079",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NV",
            "license": "811981",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "1989 Miamisburg Centerville Rd Ste 201",
            "city": "Dayton",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454593858",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "twilliams640881@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "1989 Miamisburg Centerville Rd Ste 201",
            "city": "Dayton",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454593858",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fairchild AFB, WA

Sources for this page

Verify at the official NPI Registry.