Individual provider Active NPI

Justin Michael Williams, PA-C

  • Surgical Physician Assistant
  • Oro Valley, AZ
National Provider Identifier
1508457193
Registry record updated Jan 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
Practice address
257 E Crooked Stick Dr
Oro Valley, AZ 85737-7929
Phone
(520) 401-9171
NPI assigned
Jan 27, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 27, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X Primary

Addresses

Primary practice location

257 E Crooked Stick Dr
Oro Valley, AZ 85737-7929

Mailing address

257 E Crooked Stick Dr
Oro Valley, AZ 85737-7929
Phone (520) 401-9171

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20210317002723 AZ Practitioner - Physician Assistant 8123435112 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tucson Physician Group Holdings LLCGroup PAC ID 0547560070, 200 clinicians

Practice addresses (Care Compare)

395 N Silverbell Rd
Suite 355
Tucson, AZ 85745-2981
Phone (520) 622-5912

6567 E Carondelet Dr
Suite 305
Tucson, AZ 85710-6160
Phone (520) 881-8400

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Carondelet Medical Group, Inc Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: justin.williams.1@600.direct.athenahealth.com

Organizations & group practices 2

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 5

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": "1611705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611705600000",
    "number": "1508457193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "257 E CROOKED STICK DR",
            "city": "ORO VALLEY",
            "state": "AZ",
            "postal_code": "857377929",
            "telephone_number": "520-401-9171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "257 E CROOKED STICK DR",
            "city": "ORO VALLEY",
            "state": "AZ",
            "postal_code": "857377929",
            "telephone_number": "520-401-9171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "JUSTIN",
        "middle_name": "MICHAEL",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-01-27",
        "last_updated": "2021-01-27",
        "certification_date": "2021-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oro Valley, AZ

Sources for this page

Verify at the official NPI Registry.