Active NPI
Jonathan Williams
- Family Medicine Physician
- Roseburg, OR
National Provider Identifier
1699529099
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- PG220347
- Practice address
- 150 NE Kenneth Ford Dr
Roseburg, OR 97470-1042 - Phone
- (541) 672-9596
- NPI assigned
- Apr 15, 2024
- Sex
- Male
- 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 Medicine Physician | 207Q00000X | PG220347 | OR | Primary |
Addresses
Primary practice location
150 NE Kenneth Ford Dr
Roseburg, OR 97470-1042
Mailing address
24920 Mound St
Loma Linda, CA 92350-0202
Phone (541) 441-3705
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240702002747 | OR | Order and Referring Only - Family Practice | 1951845817 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PG220347 | OR | MD | Family Medicine Physician |
Interoperability endpoints
- jonathan.williams.1@17792.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1713139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713139200000",
"number": "1699529099",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24920 MOUND ST",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923500202",
"telephone_number": "541-441-3705"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 NE KENNETH FORD DR",
"city": "ROSEBURG",
"state": "OR",
"postal_code": "974701042",
"telephone_number": "541-672-9596"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "JONATHAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-04-15",
"last_updated": "2024-04-15",
"certification_date": "2024-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OR",
"license": "PG220347",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roseburg, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2024; 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.