Jerry K Williams Jr., M.D.

Primary specialty

Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X

License

94-167 Issued in NM

Practice address

2301 7TH St
Suite B
Las Vegas, NM 87701-4966

Phone

(505) 426-1200

Fax

(505) 426-1202

NPI assigned

Sep 22, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jul 6, 2018 through Jul 6, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• High Desert Neurology

  • Neurology with Special Qualifications in Child Neurology Physician
  • Rio Rancho, NM
  • NPI 1487754735

  Single Specialty

  NPD (past) Authorized official
• San Miguel Hospital Corporation

  dba Alta Vista Regional Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Las Vegas, NM
  • NPI 1598537862
  NPD (past)

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1710086749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3861",
            "city": "LAS VEGAS",
            "state": "NM",
            "postal_code": "877016861",
            "telephone_number": "505-426-1200",
            "fax_number": "505-426-1202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 7TH ST",
            "address_2": "SUITE B",
            "city": "LAS VEGAS",
            "state": "NM",
            "postal_code": "877014966",
            "telephone_number": "505-426-1200",
            "fax_number": "505-426-1202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "JERRY",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-22",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "NM",
            "license": "94-167",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "23432",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP & SALUD",
            "identifier": "201047864",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "201311184",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MUTUAL OF OMAHA",
            "identifier": "NM9999",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED AMERICAN",
            "identifier": "C100521093",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "00NM009T07",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan Wetherill, CPSW.FPSW,CCSS
• Paula Wetterer, MS, SLP-CCC
• Darren Wheat, BMS
• Alaina White
• Brenda White, M.D.
• John Berrtrum Williams, BMS
• Kelly Williams
• Melissa Ann Williamson, LCSW
• Gemenia Wofford
• Robyn Wood Millard, BMS

• Neurology with Special Qualifications in Child Neurology Physician in Las Vegas, NM
• Providers in Las Vegas, NM by specialty
• Neurology with Special Qualifications in Child Neurology Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.