NPIMap

Individual provider Active NPI

Derek Frank Williams, M.D.

  • Family Medicine Physician
  • Hawthorne, CA
National Provider Identifier
1467405753
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A72933 Issued in CA
Practice address
11633 Hawthorne Blvd
Suite 410
Hawthorne, CA 90250-2321
Phone
(310) 792-4450
Fax
(310) 792-4455
NPI assigned
May 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A72933 CA Primary

Addresses

Primary practice location

11633 Hawthorne Blvd
Suite 410
Hawthorne, CA 90250-2321

Mailing address

11633 Hawthorne Blvd
Suite 410
Hawthorne, CA 90250-2321
Phone (310) 792-4450

Other identifiers 1

IdentifierTypeStateIssuer
00G157110MedicaidCA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dwilliams191540@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20051103001219 CA Practitioner - Family Practice 3971521394 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Missouri, Kansas City, School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providence Medical InstituteGroup PAC ID 5991609737, 303 clinicians

Practice addresses (Care Compare)

Laguna Niguel, CA 92677

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A72933CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Institute Family Medicine Current Accepting new patients
Providence Medical Institute Family Medicine CurrentSince Nov 1, 2007 Accepting new patients
Providence Medical Institute Family Medicine CurrentSince Nov 1, 2007 Accepting new patients
University of Kansas Hospital Authority Past Accepting new patients
La Vida Multispecialty Medical Group Inc Past Accepting new patients
Prairie Medical Group Past Accepting new patients
La Vida Multi-Specialty Medical Group Past Accepting new patients

Locations

21501 Avalon Blvd
Ste 100
Carson, CA 90745
Phone (310) 835-6627

12618 Hawthorne Blvd
Hawthorne, CA 90250
Phone (310) 263-5700

11633 Hawthorne Blvd
Ste 410
Hawthorne, CA 90250
Phone (310) 792-4450

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: dwilliams191540@oc.providencedirect.org

Organizations & group practices 7

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": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1467405753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11633 HAWTHORNE BLVD",
            "address_2": "SUITE 410",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902502321",
            "telephone_number": "310-792-4450",
            "fax_number": "310-792-4455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11633 HAWTHORNE BLVD",
            "address_2": "SUITE 410",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902502321",
            "telephone_number": "310-792-4450",
            "fax_number": "310-792-4455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "DEREK",
        "middle_name": "FRANK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-18",
        "last_updated": "2023-03-07",
        "certification_date": "2021-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A72933",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G157110",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dwilliams191540@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "12618 Hawthorne Blvd",
            "city": "Hawthorne",
            "state": "CA",
            "country_code": "US",
            "postal_code": "902503907",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hawthorne, CA

Sources for this page

Verify at the official NPI Registry.