Individual provider Active NPI

Bruce Edward Williams, D.P.M.

  • Podiatrist
  • Merrillville, IN
National Provider Identifier
1689617508
Registry record updated Dec 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
07000747 Issued in IN
Practice address
8120 Georgia St
Suite B
Merrillville, IN 46410-6390
Phone
(847) 390-7666
Fax
(847) 390-9345
NPI assigned
Jun 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 07000747 IN Primary
Foot & Ankle Surgery Podiatrist 213ES0103X 016004547 IL

Addresses

Primary practice location

8120 Georgia St
Suite B
Merrillville, IN 46410-6390

Mailing address

1455 E Golf Rd
Suite 110
Des Plaines, IL 60016-1250
Phone (847) 390-7666

Other identifiers 2

IdentifierTypeStateIssuer
016004547MedicaidIL
100167720AMedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140520002587 IL Practitioner - Podiatry 9931230521 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vitae Health Medical Illinois, PLLCGroup PAC ID 2365798410, 214 clinicians

Practice addresses (Care Compare)

127 W Diversey Ave
Elmhurst, IL 60126-1101
Phone (630) 530-5225

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions1-10
Removal of nail tissue1558
Removal or shaving of skin growth1219

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Vitae Health Medical Illinois, PLLC CurrentSince May 1, 2024 Accepting new patients

Locations

303 E Wacker Dr
Ste 1127
Chicago, IL 60601
Phone (312) 328-2347

1366 W Fullerton Ave
Chicago, IL 60614
Phone (630) 734-0640

5130 W Jackson Blvd
Chicago, IL 60644
Phone (773) 287-1429

420 W Butterfield Rd
Elmhurst, IL 60126
Phone (630) 832-2300

127 W Diversey Ave
Elmhurst, IL 60126
Phone (630) 530-5225

3450 Oakton St
Ste 300
Skokie, IL 60076

9700 Gross Point Rd
Skokie, IL 60076
Phone (847) 674-7210

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": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481673600000",
    "number": "1689617508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1455 E GOLF RD",
            "address_2": "SUITE 110",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600161250",
            "telephone_number": "847-390-7666",
            "fax_number": "847-390-9345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8120 GEORGIA ST",
            "address_2": "SUITE B",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464106390",
            "telephone_number": "847-390-7666",
            "fax_number": "847-390-9345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "BRUCE",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2016-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "IN",
            "license": "07000747",
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IL",
            "license": "016004547",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016004547",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100167720A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Merrillville, IN

Sources for this page

Verify at the official NPI Registry.