Active NPI
Shantrice Marseille Williams, F.N.P.
- Family Nurse Practitioner
- San Diego, CA
National Provider Identifier
1578865549
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 19664
- Practice address
- 4060 Fairmount Ave
San Diego, CA 92105-1608 - Phone
- (619) 564-7017
- NPI assigned
- Nov 24, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 19664 | CA | Primary |
Addresses
Primary practice location
4060 Fairmount Ave
San Diego, CA 92105-1608
Mailing address
4060 Fairmount Ave
San Diego, CA 92105-1608
Phone (619) 564-7017
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19664 | CA | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Neighborhood Healthcare | Current | Accepting new patients | |
| Neighborhood Healthcare | Current | Accepting new patients |
Locations
855 E Madison Ave
El Cajon, CA 92020
Phone (619) 440-2751
425 N Date St
Escondido, CA 92025
Phone (760) 737-2035
425 N Date St
#0
Escondido, CA 92025
13010 Poway Rd
Poway, CA 92064
Phone (858) 218-3000
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
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.
-
- Federally Qualified Health Center (FQHC)
- Escondido, CA
- NPI 1598703647
-
- Federally Qualified Health Center (FQHC)
- Beaumont, CA
- NPI 1629601653
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1290556800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486598400000",
"number": "1578865549",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4060 FAIRMOUNT AVE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921051608",
"telephone_number": "619-564-7017"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4060 FAIRMOUNT AVE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921051608",
"telephone_number": "619-564-7017"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "SHANTRICE",
"middle_name": "MARSEILLE",
"name_prefix": "Ms.",
"credential": "F.N.P.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-11-24",
"last_updated": "2017-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "CA",
"license": "19664",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2017; 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.