Fontaine Williams

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

APRN.CNP.17004 Issued in OH

Practice address

2350 Miami Valley Dr Ste 500
Centerville, OH 45459-4780

Phone

(937) 293-1622

Fax

(937) 245-6308

NPI assigned

Oct 28, 2014

Last updated

Dec 31, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: admin@dpn.oncoemrdirect.com

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.

• Dayton Physicians, LLC

  dba Dayton Physicians

  • Hematology & Oncology Physician
  • Dayton, OH
  • NPI 1902844947
  Medicare reassignment NPD
• Premier Health Specialists Inc

  • Internal Medicine Physician
  • Moraine, OH
  • NPI 1194958223
  Medicare reassignment NPD
• Suresh Gupta MD Inc

  dba Pain Management Associates

  • Specialist
  • Dayton, OH
  • NPI 1508895640
  Medicare reassignment NPD
• Dayton Physicians, LLC

  dba Dayton Physicians

  • Durable Medical Equipment & Medical Supplies
  • Dayton, OH
  • NPI 1811141559
  NPD
• Premier Health Specialists Inc

  dba Advanced Ankle and Foot Specialists

  • Foot & Ankle Surgery Podiatrist
  • Dayton, OH
  • NPI 1902211287
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1414454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609372800000",
    "number": "1467857896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6680 POE AVE STE 200",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454142855",
            "telephone_number": "937-293-1622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2350 MIAMI VALLEY DR STE 500",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454594780",
            "telephone_number": "937-293-1622",
            "fax_number": "937-245-6308"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2222 Philadelphia Dr",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454061813",
            "country_code": "US",
            "telephone_number": "937-734-5567",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2222 Philadelphia Dr",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454061813",
            "country_code": "US",
            "telephone_number": "937-734-5567",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Wyoming St",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454092722",
            "country_code": "US",
            "telephone_number": "937-208-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "FONTAINE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-10-28",
        "last_updated": "2020-12-31",
        "certification_date": "2020-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "OH",
            "license": "APRN.CNP.17004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0203376",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "admin@dpn.oncoemrdirect.com",
            "affiliation": "N",
            "address_1": "2350 Miami Valley Dr Ste 500",
            "city": "Centerville",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454594780",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mary Wilbers
• Amy Dee Wildermuth, RPH
• William J. Hagerty DDS Inc (Centerville Dental Associates)
• William J. Hagerty DDS Inc.
• William J. Hagerty Dental Associates LLC
• Jenna Williams, ATC
• Jon P Williams, D.O., PH.D.
• Kristi Dawn Williams
• Austin Willis
• Julie Kaye Wilson Ellis, LPN

• Gerontology Nurse Practitioner in Centerville, OH
• Providers in Centerville, OH by specialty
• Gerontology Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2020; 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.

Verify at the official NPI Registry.