NPIMap

Individual provider Active NPI

Kevin G Williams, MD

  • Internal Medicine Physician
  • Peckville, PA
National Provider Identifier
1750361168
Registry record updated Feb 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD040444E Issued in PA
Practice address
320 Keystone Ave
Peckville, PA 18452-2242
Phone
(570) 489-0871
Fax
(570) 489-8021
NPI assigned
Jan 20, 2006
Last updated
Feb 10, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD040444E PA Primary

Addresses

Primary practice location

320 Keystone Ave
Peckville, PA 18452-2242

Mailing address

320 Keystone Ave
Peckville, PA 18452-2242
Phone (570) 489-0871

Other identifiers 1

IdentifierTypeStateIssuer
001162219MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20100622000339 PA Practitioner - Internal Medicine 2860575354 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Temple University School of Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Geisinger ClinicGroup PAC ID 5395657001, 3,432 clinicians

Practice addresses (Care Compare)

100 N Academy Ave
Danville, PA 17822-9800
Phone (570) 271-6144

320 Keystone Ave
Peckville, PA 18452-2242
Phone (570) 489-0871

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD040444EPAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Geisinger Clinic Current Accepting new patients
Geisinger Clinic CurrentSince Oct 1, 2014 Accepting new patients
Geisinger Clinic CurrentSince Oct 1, 2014 Accepting new patients
Geisinger Clinic Past Accepting new patients

Locations

100 N Academy Ave
Danville, PA 17822

407 3rd Ave
Jessup, PA 18434
Phone (570) 383-7922

320 Keystone Ave
Peckville, PA 18452
Phone (570) 489-0871

435 Scranton Carbondale Hwy
Scranton, PA 18508
Phone (570) 343-4334

Interoperability endpoints

  • Direct secure messaging: kwilliams@primemed.medentdirect.com

Organizations & group practices 4

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 31

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

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1137715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297296000000",
    "number": "1750361168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 KEYSTONE AVE",
            "city": "PECKVILLE",
            "state": "PA",
            "postal_code": "184522242",
            "telephone_number": "570-489-0871",
            "fax_number": "570-489-8021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 KEYSTONE AVE",
            "city": "PECKVILLE",
            "state": "PA",
            "postal_code": "184522242",
            "telephone_number": "570-489-0871",
            "fax_number": "570-489-8021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "KEVIN",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-20",
        "last_updated": "2011-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD040444E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001162219",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peckville, PA

Sources for this page

Verify at the official NPI Registry.