NPIMap

Organization Active NPI

Alliance Healthcare System Inc

Doing business as Williams Medical Clinic

  • Rural Health Clinic/Center
  • Holly Springs, MS
National Provider Identifier
1821143256
Registry record updated Feb 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ALLIANCE HEALTHCARE SYSTEM INC
Doing business as
Williams Medical Clinic
Practice address
1938 Crescent Meadows Dr
Holly Springs, MS 38635-7419
Phone
(662) 252-1599
Fax
(662) 252-1986
NPI assigned
Jan 24, 2007
Last updated
Feb 25, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2015

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

Authorized official

Name
Kenneth Williams, MDNPI 1851480974
Title
Owner
Phone
(662) 252-1599

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

1938 Crescent Meadows Dr
Holly Springs, MS 38635-7419

Mailing address

1938 Crescent Meadows Dr
Holly Springs, MS 38635-7419
Phone (662) 252-1599

Other identifiers 1

IdentifierTypeStateIssuer
09013693MedicaidMS

Other names 1

  • WILLIAMS MEDICAL CLINIC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040701000719 MS Part B Supplier - Clinic/Group Practice 2961489547 Receives reassigned benefits from 24 practitioners
1 other NPI on this enrollment
Practice locations: Holly Springs, MS
O20050519000414 MS Part A Provider - Rural Health Clinic 2961489547 Practice locations: Holly Springs, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821143256. Details of each certification follow.

Rural health clinic certification: CCN 258528

Legal name
ALLIANCE HEALTHCARE SYSTEM, INC
Doing business as
WILLIAMS MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 1, 2006
Last certification
Nov 13, 2019
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Nov 1, 1999 in MS
Enrollment address
1938 Crescent Meadows Dr
Holly Springs, MS 38635-7419
Related CCNs
250012

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Marshall Med CT Marshal13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Regina Williams Individual Corporate Director May 19, 2005
W-2 Managing Employee Jul 1, 2005
Operational/Managerial ControlOperations Manager Dec 5, 2014
Progressive Medical Management Inc Organization, Holly Springs, MS Corporation 5% Or Greater Direct Ownership Interest Nov 1, 1999 100%
Operational/Managerial Control Nov 1, 1999 100%
Kenneth Williams Individual 5% Or Greater Direct Ownership Interest Nov 1, 1999 100%
Corporate OfficerOffice Administrator Nov 1, 1999 100%
Corporate Director May 19, 2005
W-2 Managing Employee Jul 1, 2005
Kathy Williams Individual W-2 Managing Employee Jan 6, 2009
Operational/Managerial ControlBusiness Manager Dec 5, 2014

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Kenneth Williams, MD
    • Internal Medicine Physician
    • Holly Springs, MS
    • NPI 1851480974

    5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer, W-2 Managing Employee

    CMS ownership

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424822400000",
    "number": "1821143256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1938 CRESCENT MEADOWS DR",
            "city": "HOLLY SPRINGS",
            "state": "MS",
            "postal_code": "386357419",
            "telephone_number": "662-252-1599",
            "fax_number": "662-252-1986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1938 CRESCENT MEADOWS DR",
            "city": "HOLLY SPRINGS",
            "state": "MS",
            "postal_code": "386357419",
            "telephone_number": "662-252-1599",
            "fax_number": "662-252-1986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLIANCE HEALTHCARE SYSTEM INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2015-02-25",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-252-1599",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09013693",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WILLIAMS MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Holly Springs, MS

Sources for this page

Verify at the official NPI Registry.