NPIMap

Individual provider Active NPI

Teresa A Williamson, M.D.

  • Family Medicine Physician
  • Pascagoula, MS
National Provider Identifier
1710989678
Registry record updated Jun 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
11797 Issued in MS
Practice address
2819 Denny Ave.
Pascagoula, MS 39581-5320
Phone
(228) 762-3466
Fax
(228) 762-6349
NPI assigned
Aug 11, 2005
Last updated
Jun 6, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2013

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 11797 MS Primary

Addresses

Primary practice location

2819 Denny Ave.
Pascagoula, MS 39581-5320

Mailing address

2819 Denny Ave
Pascagoula, MS 39581-5301
Phone (228) 762-3466

Other identifiers 2

IdentifierTypeStateIssuer
00116831MedicaidMS
5440159OtherMSAETNA ID#

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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
I20091130000162 MS Practitioner - Family Practice 0042359341 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Mississippi School of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Singing River Health SystemGroup PAC ID 3870405194, 290 clinicians

Practice addresses (Care Compare)

2809 Denny Ave
Pascagoula, MS 39581-5301
Phone (228) 818-0563

2819 Denny Ave
Pascagoula, MS 39581-5301
Phone (228) 762-3466

7001 Hwy 614
Coastal Ambulatory Services
Hurley, MS 39555-5340
Phone (228) 588-6622

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11797MSMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Singing River Health System CurrentSince Aug 28, 2009 Accepting new patients
Singing River Health System Past Accepting new patients
Singing River Health System Past Accepting new patients

Locations

2819 Denny Ave
Pascagoula, MS 39581
Phone (228) 762-3466

4211 Hospital St
Ste 202
Pascagoula, MS 39581
Phone (228) 372-8270

Organizations & group practices 3

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 67

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

View all 67

NPI Registry JSON

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370476800000",
    "number": "1710989678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2819 DENNY AVE",
            "city": "PASCAGOULA",
            "state": "MS",
            "postal_code": "395815301",
            "telephone_number": "228-762-3466",
            "fax_number": "228-762-6349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2819 DENNY AVE.",
            "city": "PASCAGOULA",
            "state": "MS",
            "postal_code": "395815320",
            "telephone_number": "228-762-3466",
            "fax_number": "228-762-6349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMSON",
        "first_name": "TERESA",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-11",
        "last_updated": "2013-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "11797",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00116831",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA ID#",
            "identifier": "5440159",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pascagoula, MS

Sources for this page

Verify at the official NPI Registry.