Charles Iokepa Williams, NP-C

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

R166936-9 Issued in MN

Practice address

1660 Hwy 100 South
Suite 145
St. Louis Park, MN 55416-1562

Phone

(952) 456-6160

Fax

(952) 456-6184

NPI assigned

Nov 9, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MN, WI, TX, OH4 enrollments

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 4

Specialty

Nurse Practitioner

Education

Other, 2012

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/18208/brand/1/csg/1/fhir/r4

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.

• Community Care Health Network LLC

  • Nurse Practitioner
  • Nashville, TN
  • NPI 1619368842

  OH

  Medicare reassignment NPD
• Elite Therapy Institute LLC

  • Physical Therapy Clinic/Center
  • Rice Lake, WI
  • NPI 1760576789
  Medicare reassignment NPD
• Matrix Medical Plus

  • Nurse Practitioner
  • Nashville, TN
  • NPI 1376973461

  MN

  Medicare reassignment NPD
• Daniel B Grossman M D Inc

  • Medical Specialty Clinic/Center
  • Orange, CA
  • NPI 1922739366
  NPD (past)

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

{
    "created_epoch": "1352419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366329600000",
    "number": "1659625879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1660 HIGHWAY 100 SOUTH",
            "address_2": "SUITE 145",
            "city": "ST. LOUIS PARK",
            "state": "MN",
            "postal_code": "554161562",
            "telephone_number": "952-456-6160",
            "fax_number": "952-456-6184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1660 HWY 100 SOUTH",
            "address_2": "SUITE 145",
            "city": "ST. LOUIS PARK",
            "state": "MN",
            "postal_code": "554161562",
            "telephone_number": "952-456-6160",
            "fax_number": "952-456-6184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "CHARLES",
        "middle_name": "IOKEPA",
        "name_prefix": "Mr.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-11-09",
        "last_updated": "2013-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MN",
            "license": "166936-9",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MN",
            "license": "R166936-9",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL PTAN",
            "identifier": "500008394",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "C09271",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Joy Willems, NP-C
• Anton Willerscheidt
• Allison L Williams, MD
• Amanda Mae Williams, LICSW
• Anika Williams
• Katherine Frances Williams, PA-C
• Nicole Williams, DPT
• Paul Williams
• Ryan Paal Williams, DPT
• Sarah Jayne Anderson Williams, M.D.

• Adult Health Nurse Practitioner in St. Louis Park, MN
• Providers in St. Louis Park, MN by specialty
• Adult Health Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2013; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.