Individual provider Active NPI

Patrick Dale Williams

  • Acute Care Nurse Practitioner
  • Rock Hill, SC
National Provider Identifier
1720453954
Registry record updated Jul 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
23337 Issued in SC
Practice address
222 Herlong Ave S
Rock Hill, SC 29732-1158
Phone
(803) 329-1234
NPI assigned
Dec 14, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 11, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X AP130336 TX
Acute Care Nurse Practitioner 363LA2100X 23337 SC Primary
Nurse Practitioner 363L00000X 1-137158 AL
Acute Care Nurse Practitioner 363LA2100X 5010304 NC

Addresses

Primary practice location

222 Herlong Ave S
Rock Hill, SC 29732-1158

Mailing address

7206 Irongate Dr
Lancaster, SC 29720-0321
Phone (256) 393-6912

Other practice location 1

557 Brookdale Dr
Statesville, NC 28677-4107
Phone (704) 873-5661

Other identifiers 1

IdentifierTypeStateIssuer
362926301MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, AL, SC3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20180605001105 NC Practitioner - Nurse Practitioner 7416244702 Reassigns benefits to 1 organization
I20190221000623 AL Practitioner - Nurse Practitioner 7416244702 Reassigns benefits to 2 organizations
I20191216002922 SC Practitioner - Nurse Practitioner 7416244702 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Alabama School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carolinas Physicians Network IncGroup PAC ID 3375449655, 2,324 clinicians

Practice addresses (Care Compare)

100 Medical Park Dr
Suite 210
Concord, NC 28025-2966
Phone (704) 403-6100

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1-137158ALMDNurse Practitioner
5010304NCMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
HH Observation Center CurrentSince Oct 20, 2024 Accepting new patients
Emergency Physicians Group CurrentSince Sep 13, 2024 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Feb 9, 2026 Accepting new patients
Southeastern Hospitalist Services PC Nurse Practitioner CurrentSince Nov 1, 2019 Accepting new patients

Locations

101 Sivley Rd SW
Huntsville, AL 35801
Phone (256) 265-9870

10650 Park Rd
Charlotte, NC 28210
Phone (704) 667-0337

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

100 Medical Park Dr
Ste 210
Concord, NC 28025
Phone (704) 403-6100

809 82nd Pkwy
Myrtle Beach, SC 29572
Phone (843) 291-7182

222 Herlong Ave S
Rock Hill, SC 29732
Phone (803) 324-1950

Organizations & group practices 5

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.

Hospital & facility affiliations 2

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": "1450051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657497600000",
    "number": "1720453954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7206 IRONGATE DR",
            "city": "LANCASTER",
            "state": "SC",
            "postal_code": "297200321",
            "telephone_number": "256-393-6912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 HERLONG AVE S",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297321158",
            "telephone_number": "803-329-1234"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "557 Brookdale Dr",
            "address_purpose": "LOCATION",
            "city": "Statesville",
            "state": "NC",
            "postal_code": "286774107",
            "country_code": "US",
            "telephone_number": "704-873-5661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "PATRICK",
        "middle_name": "DALE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-12-14",
        "last_updated": "2022-07-11",
        "certification_date": "2022-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "AP130336",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "SC",
            "license": "23337",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AL",
            "license": "1-137158",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NC",
            "license": "5010304",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "362926301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rock Hill, SC

Sources for this page

Verify at the official NPI Registry.