Active NPI
Lillie Mae Williams, M.D.
- Pediatrics Physician
- Moreno Valley, CA
National Provider Identifier
1588665111
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- G45814
- Practice address
- 24853 Alessandro Blvd
#4
Moreno Valley, CA 92553-6102 - Phone
- (915) 571-8518
- Fax
- (877) 778-9427
- NPI assigned
- Aug 4, 2005
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental - Behavioral Pediatrics Physician | 2080P0006X | G45814 | CA | |
| Pediatrics Physician | 208000000X | G45814 | CA | Primary |
Addresses
Primary practice location
24853 Alessandro Blvd
#4
Moreno Valley, CA 92553-6102
Mailing address
625 Fair Oaks Ave Ste 270
South Pasadena, CA 91030-5801
Phone (626) 346-1239
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G458140 | Other | CA | MEDI CAL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G45814 | CA | MD | Developmental - Behavioral Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Memorial Medical Group Inc | Past | Accepting new patients | |
| Talbert Medical Group, P.C. | Pediatrics | Past | Accepting new patients |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Interoperability endpoints
- lwilliamsmd17716@direct.memorialcare.org
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.
-
- Internal Medicine Physician
- Fountain Valley, CA
- NPI 1528069176
Pediatrics
-
- Durable Medical Equipment & Medical Supplies
- Phoenix, AZ
- NPI 1255523643
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123113600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522627200000",
"number": "1588665111",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "625 FAIR OAKS AVE STE 270",
"city": "SOUTH PASADENA",
"state": "CA",
"postal_code": "910305801",
"telephone_number": "626-346-1239",
"fax_number": "626-639-3005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24853 ALESSANDRO BLVD",
"address_2": "#4",
"city": "MORENO VALLEY",
"state": "CA",
"postal_code": "925536102",
"telephone_number": "915-571-8518",
"fax_number": "877-778-9427"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "LILLIE",
"middle_name": "MAE",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-08-04",
"last_updated": "2018-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0006X",
"taxonomy_group": "",
"desc": "Pediatrics, Developmental - Behavioral Pediatrics",
"state": "CA",
"license": "G45814",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "G45814",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDI CAL",
"identifier": "00G458140",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Moreno Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.