NPIMap

Individual provider Active NPI

William Brian Womack, D.O.

  • Family Medicine Physician
  • Fort Mohave, AZ
National Provider Identifier
1679678205
Registry record updated Jan 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
3527 Issued in AZ
Practice address
1611 Joy LN
Fort Mohave, AZ 86426-8807
Phone
(928) 768-9496
NPI assigned
Sep 14, 2006
Last updated
Jan 5, 2010By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 5, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 3527 AZ Primary

Addresses

Primary practice location

1611 Joy LN
Fort Mohave, AZ 86426-8807

Mailing address

P.0. Box 9479
Fort Mohave, AZ 86426
Phone (928) 768-9496

Other identifiers 2

IdentifierTypeStateIssuer
518144MedicaidAZ
71873OtherAZPTAN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080213000328 AZ Practitioner - Family Practice 1850348343 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
College of Osteo Med of the Pacific at Pomona, 1996
Medicare assignment
May accept Medicare assignment
Group practices
Mohave Family HealthcareGroup PAC ID 2860575941, 4 clinicians
Paragon Physical Therapy and Rehab LLCGroup PAC ID 4284902339, 87 clinicians

Practice addresses (Care Compare)

1611 Joy Lane
Fort Mohave, AZ 86426-8807
Phone (928) 768-9496

1611 Joy LN
Fort Mohave, AZ 86426-8807

2585 Miracle Mile
Bullhead City, AZ 86442-7522

2735 Silver Creek Rd
Bullhead City, AZ 86442-7924
Phone (928) 763-2273

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mohave Family Healthcare Family Medicine CurrentSince Jan 1, 2003 Accepting new patients
Comprehensive Hospitalist Services of Arizona, LLC CurrentSince Apr 8, 2017 Accepting new patients
Comprehensive Hospitalist Services of Arizona LLC Current Accepting new patients
Bullhead City Hospital Corporation Past Accepting new patients

Locations

2735 Silver Creek Rd
Bullhead City, AZ 86442
Phone (520) 763-2273

1611 E Joy Ln
Fort Mohave, AZ 86426
Phone (928) 768-9496

1611 E Joy Ln
Ste 1
Fort Mohave, AZ 86426
Phone (757) 251-0879

1611 E Joy Ln
Ste B
Fort Mohave, AZ 86426
Phone (928) 788-8000

5300 S Highway 95
Ste A
Fort Mohave, AZ 86426
Phone (928) 768-9496

1301 S Crismon Rd
Mesa, AZ 85209
Phone (480) 358-6300

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CIAHCD
  • Direct secure messaging: wbwomack@yourcarecommunity.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
River Valley HospiceBig River, CA, CCN 751698 Hospice Contracted Managing Employee Jul 21, 2017

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1262649600000",
    "number": "1679678205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.0. BOX 9479",
            "city": "FORT MOHAVE",
            "state": "AZ",
            "postal_code": "86426",
            "telephone_number": "928-768-9496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 JOY LN",
            "city": "FORT MOHAVE",
            "state": "AZ",
            "postal_code": "864268807",
            "telephone_number": "928-768-9496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOMACK",
        "first_name": "WILLIAM",
        "middle_name": "BRIAN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-14",
        "last_updated": "2010-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "3527",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "518144",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "71873",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Mohave, AZ

Sources for this page

Verify at the official NPI Registry.