Individual provider Active NPI

Thomas Ralph Williams IV, D.O.

  • Emergency Medicine Physician
  • Tacoma, WA
National Provider Identifier
1558488445
Registry record updated Mar 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
OP60080001 Issued in WA
Practice address
9040 Jackson Ave
Tacoma, WA 98431-3004
Phone
(253) 968-2252
NPI assigned
Mar 23, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X OP60080001 WA Primary

Addresses

Primary practice location

9040 Jackson Ave
Tacoma, WA 98431-3004

Mailing address

8507 23Rd Street CT W
University Place, WA 98466-2800
Phone (253) 227-6509

Other practice location 1

11315 Bridgeport Way SW
Lakewood, WA 98499-3004
Phone (253) 985-8700

Other identifiers 4

IdentifierTypeStateIssuer
OP60080001OtherWAWASHINGTON STATE
0102202983OtherVAMEDICAL LICENSE
12308423OtherCAQH
5101017126OtherMIMEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120525000054 WA Practitioner - Emergency Medicine 0244416113 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Emergency Physicians LLC Emergency Medicine CurrentSince Jun 1, 2012 Accepting new patients

Locations

888 Swift Blvd
Richland, WA 99352
Phone (509) 942-2115

1717 S J St
Tacoma, WA 98405
Phone (253) 426-4101

11315 Bridgeport Way SW
Tacoma, WA 98499
Phone (253) 588-1711

Interoperability endpoints

  • Direct secure messaging: twilliams10045@fhsce.catholichealth.net

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616976000000",
    "number": "1558488445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8507 23RD STREET CT W",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984662800",
            "telephone_number": "253-227-6509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9040 JACKSON AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984313004",
            "telephone_number": "253-968-2252"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11315 Bridgeport Way SW",
            "address_purpose": "LOCATION",
            "city": "Lakewood",
            "state": "WA",
            "postal_code": "984993004",
            "country_code": "US",
            "telephone_number": "253-985-8700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "THOMAS",
        "middle_name": "RALPH",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-23",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WA",
            "license": "OP60080001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASHINGTON STATE",
            "identifier": "OP60080001",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "0102202983",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12308423",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "5101017126",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.