Active NPI
Nicole Burgos Williams, NP
- Physical Medicine & Rehabilitation Physician
- Sacramento, CA
National Provider Identifier
1457934465
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- 95017049
- Practice address
- 2801 K St Ste 410
Sacramento, CA 95816-5119 - Phone
- (916) 389-7100
- NPI assigned
- Apr 28, 2021
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | 95017049 | CA | Primary |
Addresses
Primary practice location
2801 K St Ste 410
Sacramento, CA 95816-5119
Mailing address
1257 56TH Ave
Sacramento, CA 95831-3146
Phone (562) 565-9163
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210813001122 | CA | Order and Referring Only - Nurse Practitioner | 2466856372 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1619568000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1619568000000",
"number": "1457934465",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1257 56TH AVE",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958313146",
"telephone_number": "562-565-9163"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2801 K ST STE 410",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958165119",
"telephone_number": "916-389-7100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "NICOLE",
"middle_name": "BURGOS",
"name_prefix": "Mrs.",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-28",
"last_updated": "2021-04-28",
"certification_date": "2021-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "CA",
"license": "95017049",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.