NPIMap

Individual provider Active NPI

Audrea Raina Williams, PA-C

  • Physician Assistant
  • Menominee, MI
National Provider Identifier
1780964205
Registry record updated Sep 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601006128 Issued in MI
Practice address
1100 10TH Street
Menominee, MI 49858-3239
Phone
(906) 863-7897
Fax
(906) 863-5762
NPI assigned
Aug 29, 2011
Last updated
Sep 12, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601006128 MI Primary

Addresses

Primary practice location

1100 10TH Street
Menominee, MI 49858-3239

Mailing address

PO Box 22487
Green Bay, WI 54305-2487
Phone (920) 445-7226

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, WI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20111004000047 MI Practitioner - Physician Assistant 1850563453 Reassigns benefits to 4 organizations
I20150810001923 WI Practitioner - Physician Assistant 1850563453 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aspirus KeweenawGroup PAC ID 8123912011, shared by 7 NPIs, 116 clinicians

Practice addresses (Care Compare)

205 Osceola St
Laurium, MI 49913-2134
Phone (906) 337-3100

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5601006128MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Oconto Hospital & Medical Center Inc CurrentSince May 17, 2017 Accepting new patients
St. Vincent Hospital-Hospital Sisters-Third Order of St. Francis CurrentSince Oct 6, 2018 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Oct 6, 2018 Accepting new patients
Aspirus Iron River Hospital & Clinics, Inc. CurrentSince May 1, 2020 Accepting new patients
Oconto Hospital & Medical Center, Inc. CurrentSince May 17, 2017 Accepting new patients
Aspirus Ironwood Hospital & Clinics, Inc. CurrentSince May 1, 2020 Accepting new patients
Aspirus Ironwood Hospital & Clinics, Inc. Physician Assistant CurrentSince May 1, 2020 Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

106 S School Rd
Daggett, MI 49821
Phone (906) 753-2155

1400 W Ice Lake Rd
Iron River, MI 49935
Phone (906) 265-6121

N10561 Grandview Ln
Ironwood, MI 49938
Phone (906) 932-1500

N10565 Grandview Ln
Ironwood, MI 49938
Phone (906) 932-1500

1100 10th St
Menominee, MI 49858
Phone (906) 863-2256

1726 Shawano Ave
Green Bay, WI 54303
Phone (920) 432-6016

835 S Van Buren St
Green Bay, WI 54301
Phone (888) 901-7246

3100 Shore Dr
Marinette, WI 54143
Phone (715) 735-4200

820 Arbutus Ave
Oconto, WI 54153
Phone (920) 835-1100

Interoperability endpoints

  • Direct secure messaging: awilliams57430@direct.aspirus.org

Organizations & group practices 10

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 4

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": "1314576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1505174400000",
    "number": "1780964205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22487",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543052487",
            "telephone_number": "920-445-7226",
            "fax_number": "920-445-7229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 10TH STREET",
            "city": "MENOMINEE",
            "state": "MI",
            "postal_code": "498583239",
            "telephone_number": "906-863-7897",
            "fax_number": "906-863-5762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "AUDREA",
        "middle_name": "RAINA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-29",
        "last_updated": "2017-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601006128",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Menominee, MI

Sources for this page

Verify at the official NPI Registry.