NPIMap

Individual provider Active NPI

Brent Richard Williams, MD

  • Urology Physician
  • Fargo, ND
National Provider Identifier
1710125893
Registry record updated May 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
11253 Issued in ND
Practice address
801 Broadway N
Fargo, ND 58102-3641
Phone
(701) 234-2301
NPI assigned
Jan 28, 2009
Last updated
May 31, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 31, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 57.007614 OH
Urology Physician 208800000X 11253 ND Primary

Addresses

Primary practice location

801 Broadway N
Fargo, ND 58102-3641

Mailing address

2422 20TH St SW
Jamestown, ND 58401
Phone (330) 671-7783

Other identifiers 1

IdentifierTypeStateIssuer
10698MedicaidND

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bwilliams1841802@direct.sanfordhealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND
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
I20090806000731 ND Practitioner - Urology 8921151093 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of North Dakota School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lutheran Charity AssociationGroup PAC ID 2264341031, shared by 6 NPIs, 168 clinicians
Innovis Health LLCGroup PAC ID 9931298155, 561 clinicians

Practice addresses (Care Compare)

2422 20TH St SW
Jamestown, ND 58401-6201
Phone (701) 252-1050

3000 32ND Ave S
Fargo, ND 58103-6132
Phone (701) 364-8000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11253NDMDUrology Physician
57.007614OHMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lutheran Charity Association CurrentSince May 1, 2022 Accepting new patients
Innovis Health LLC CurrentSince May 6, 2022 Accepting new patients
Innovis Health, LLC Current Accepting new patients
Lutheran Charity Association Current Accepting new patients
Lutheran Charity Association CurrentSince May 1, 2022 Accepting new patients
Lutheran Charity Association Current Accepting new patients
Innovis Health, LLC CurrentSince May 6, 2022 Accepting new patients
Lutheran Charity Association Past Accepting new patients

Locations

1720 US Highway 59 SE
Thief Rvr Fls, MN 56701
Phone (218) 681-4747

3000 32nd Ave S
Fargo, ND 58103
Phone (701) 364-3000

2422 20th St SW
Jamestown, ND 58401
Phone (701) 252-1050

Interoperability endpoints

  • Direct secure messaging: bwilliams1841802@direct.sanfordhealth.org

Organizations & group practices 9

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 9

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

NPI Registry JSON

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

{
    "created_epoch": "1233100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685491200000",
    "number": "1710125893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2422 20TH ST SW",
            "city": "JAMESTOWN",
            "state": "ND",
            "postal_code": "58401",
            "telephone_number": "330-671-7783",
            "fax_number": "701-952-4564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 BROADWAY N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581023641",
            "telephone_number": "701-234-2301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "BRENT",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-01-28",
        "last_updated": "2023-05-31",
        "certification_date": "2023-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "OH",
            "license": "57.007614",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "ND",
            "license": "11253",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10698",
            "state": "ND"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bwilliams1841802@direct.sanfordhealth.org",
            "affiliation": "N",
            "address_1": "801 Broadway N",
            "city": "Fargo",
            "state": "ND",
            "country_code": "US",
            "postal_code": "581023641",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.