Active NPI
Derrick Jose Williams
- Private Vehicle
- Canton, OH
National Provider Identifier
1780370825
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Private Vehicle
- License
- RP085271
- Practice address
- 2013 7TH St NE
Canton, OH 44704-1969 - Phone
- (330) 232-0379
- NPI assigned
- Apr 12, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Delivered Meals | 332U00000X | RP085271 | OH | |
| Homemaker | 376J00000X | RP085271 | OH | |
| Respite Care | 385H00000X | RP085271 | OH | |
| Child Mental Illness Respite Care | 385HR2055X | RP085271 | OH | |
| Child Intellectual and/or Developmental Disabilities Respite Care | 385HR2060X | RP085271 | OH | |
| Private Vehicle | 347C00000X | RP085271 | OH | Primary |
Addresses
Primary practice location
2013 7TH St NE
Canton, OH 44704-1969
Mailing address
2013 7TH St NE
Canton, OH 44704-1969
Phone (330) 232-0379
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RP085271 | OH | MD | Home Delivered Meals |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1681257600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694736000000",
"number": "1780370825",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2013 7TH ST NE",
"city": "CANTON",
"state": "OH",
"postal_code": "447041969",
"telephone_number": "330-232-0379"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2013 7TH ST NE",
"city": "CANTON",
"state": "OH",
"postal_code": "447041969",
"telephone_number": "330-232-0379"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "DERRICK",
"middle_name": "JOSE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-04-12",
"last_updated": "2023-09-15",
"certification_date": "2023-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "332U00000X",
"taxonomy_group": "",
"desc": "Home Delivered Meals",
"state": "OH",
"license": "RP085271",
"primary": false
},
{
"code": "376J00000X",
"taxonomy_group": "",
"desc": "Homemaker",
"state": "OH",
"license": "RP085271",
"primary": false
},
{
"code": "385H00000X",
"taxonomy_group": "",
"desc": "Respite Care",
"state": "OH",
"license": "RP085271",
"primary": false
},
{
"code": "385HR2055X",
"taxonomy_group": "",
"desc": "Respite Care, Respite Care, Mental Illness, Child",
"state": "OH",
"license": "RP085271",
"primary": false
},
{
"code": "385HR2060X",
"taxonomy_group": "",
"desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
"state": "OH",
"license": "RP085271",
"primary": false
},
{
"code": "347C00000X",
"taxonomy_group": "",
"desc": "Private Vehicle",
"state": "OH",
"license": "RP085271",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.