Individual provider Active NPI

Thomas C. Williams, M.D.

  • Anesthesiology Physician
  • Russellville, AR
National Provider Identifier
1790786408
Registry record updated Jun 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
C7989 Issued in AR
Practice address
1808 W Main St
Russellville, AR 72801-2724
Phone
(479) 968-2841
NPI assigned
Aug 3, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X C7989 AR Primary

Addresses

Primary practice location

1808 W Main St
Russellville, AR 72801-2724

Mailing address

PO Box 1351
Russellville, AR 72811-1351
Phone (800) 235-1415

Other identifiers 4

IdentifierTypeStateIssuer
050031807OtherRR MEDICARE GROUP CC5970
770078201OtherARAR BREASTCARE
125265001MedicaidAR
5J371OtherARBLUE CROSS BLUE SHIELD AR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060328000503 AR Practitioner - Anesthesiology 8325056690 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Arkansas College of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Mary'S Specialty LLCGroup PAC ID 5496189318, 8 clinicians

Practice addresses (Care Compare)

1808 W Main St
St Mary'S Anesthesia
Russellville, AR 72801-2724
Phone (479) 968-3733

Hospital & facility affiliations

  • St Marys Regional Medical Center Hospital, Russellville, AR, CCN 040041

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C7989ARMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Mary'S Specialty LLC Anesthesiology CurrentSince Nov 9, 2019 Accepting new patients

Locations

1808 W Main St
Russellville, AR 72801
Phone (479) 964-4178

Organizations & group practices 1

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 1

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": "1123027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212451200000",
    "number": "1790786408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1351",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728111351",
            "telephone_number": "800-235-1415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1808 W MAIN ST",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728012724",
            "telephone_number": "479-968-2841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "THOMAS",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-03",
        "last_updated": "2008-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "AR",
            "license": "C7989",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE GROUP CC5970",
            "identifier": "050031807",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AR BREASTCARE",
            "identifier": "770078201",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "125265001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD AR",
            "identifier": "5J371",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Russellville, AR

Sources for this page

Verify at the official NPI Registry.