NPIMap

Individual provider Active NPI

Derek James Williams, MD

  • Family Medicine Physician
  • Clancy, MT
National Provider Identifier
1811907884
Registry record updated May 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
10496 Issued in MT
Practice address
204 Winslow Road
Clancy, MT 59634
Phone
(406) 461-0875
NPI assigned
Aug 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 10496 MT Primary

Addresses

Primary practice location

204 Winslow Road
Clancy, MT 59634

Mailing address

PO Box 256
Clancy, MT 59634-0256
Phone (406) 461-0875

Other identifiers 1

IdentifierTypeStateIssuer
72539MedicaidMT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10496MTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Logan Health - Conrad CurrentSince Apr 1, 2015 Accepting new patients
Logan Health - Conrad Current Accepting new patients
Logan Health - Conrad CurrentSince Apr 1, 2015 Accepting new patients
CMSC, LLC CurrentSince Mar 15, 2017 Accepting new patients
Frances Mahon Deaconess Hospital Past Accepting new patients
Wheatland Memorial Healthcare Family Medicine Past Accepting new patients
Big Sky Medical Clinic, PC Family Medicine Past Accepting new patients
Mountain View Family Health Care, PC Family Medicine Past Accepting new patients
Powell County Memorial Hospital Association Inc Past Accepting new patients
Powell County Memorial Hospital Association Inc Family Medicine Past Accepting new patients

Locations

809 Sunset Blvd
Conrad, MT 59425
Phone (406) 271-3211

3010 15th Ave S
Great Falls, MT 59405
Phone (406) 771-3095

1509 29th St S
Great Falls, MT 59405
Phone (406) 771-3500

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/12481/brand/1/csg/1/fhir/r4

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337558400000",
    "number": "1811907884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 256",
            "city": "CLANCY",
            "state": "MT",
            "postal_code": "596340256",
            "telephone_number": "406-461-0875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 WINSLOW ROAD",
            "city": "CLANCY",
            "state": "MT",
            "postal_code": "59634",
            "telephone_number": "406-461-0875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "DEREK",
        "middle_name": "JAMES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2012-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MT",
            "license": "10496",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "72539",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clancy, MT

Sources for this page

Verify at the official NPI Registry.