Ted Michael Williams, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA04514 Issued in TX

Practice address

703 S Fleishel Ave Ste 4000
Tyler, TX 75701-2015

Phone

(903) 606-7000

NPI assigned

Aug 18, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in TX

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

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: twilliams7624@christushealth.direct-ci.net

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.

• Christus Trinity Clinic Texas

  • Family Medicine Physician
  • Tyler, TX
  • NPI 1285684225
  Medicare reassignment NPD
• Christus Trinity Clinic Texas

  • Rural Health Clinic/Center
  • Winnsboro, TX
  • NPI 1801673165
  NPD
• Longview Emergency Medicine Associates PLLC

  • Emergency Medicine Physician
  • Marshall, TX
  • NPI 1902930589

  Physician Assistant

  NPD (past)
• Mother Frances Hospital Winnsboro

  • Rural Health Clinic/Center
  • Winnsboro, TX
  • NPI 1922294867
  NPD (past)
• Tyler Cardiovascular Consultants P.a.

  • Cardiovascular Disease Physician
  • Tyler, TX
  • NPI 1376538801
  NPD (past)

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

{
    "created_epoch": "1124323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424822400000",
    "number": "1497747273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 846098",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752846098",
            "telephone_number": "903-324-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 S FLEISHEL AVE STE 4000",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012015",
            "telephone_number": "903-606-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "TED",
        "middle_name": "MICHAEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-18",
        "last_updated": "2015-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA04514",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "184590102",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-2616977-042",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "836N57",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TEXAS",
            "identifier": "8N8739",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "184590101",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Schulundria Schantelle Williams
• Shawnteanika Marcia Williams
• Shelly Lynn Williams, APRN
• Stephanie Williams
• Susan Williams
• Tia Williams, LCSW
• Tiffany Williams
• Tywanna Williams
• Veronica M Williams, AGPCNP
• William Christopher Williams, PA-C

• Physician Assistant in Tyler, TX
• Providers in Tyler, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2015; 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.