Individual provider Active NPI

Keith Williams, M.D.

  • Pediatrics Physician
  • South Holland, IL
National Provider Identifier
1851304901
Registry record updated Dec 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
036-070902 Issued in IL
Practice address
100 W 162ND St
South Holland, IL 60473-2003
Phone
(708) 730-2200
NPI assigned
Aug 13, 2006
Last updated
Dec 21, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 036-070902 IL Primary

Addresses

Primary practice location

100 W 162ND St
South Holland, IL 60473-2003

Mailing address

2311 W 22ND St
Suite 202
Oak Brook, IL 60523-1225

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address kwilliams206341@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20100616000360 IL Practitioner - Pediatric Medicine 1658401716 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

100 W 162ND St
Advocate Med GRP S Holland
South Holland, IL 60473-2003
Phone (708) 730-2200

214 McHenry Rd
Buffalo Grove, IL 60089-6748
Phone (847) 459-1160

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-070902ILMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advocate Health and Hospitals Corporation CurrentSince Jan 1, 2013 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Jan 1, 2013 Accepting new patients

Locations

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

1945 W Wilson Ave
Fl 4
Chicago, IL 60640
Phone (773) 736-6220

29373 Network Pl
Chicago, IL 60673

100 W 162nd St
South Holland, IL 60473
Phone (708) 730-2200

Interoperability endpoints

  • Direct secure messaging: kwilliams206341@direct.myadvocateaurora.org

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640044800000",
    "number": "1851304901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2311 W 22ND ST",
            "address_2": "SUITE 202",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605231225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 W 162ND ST",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "604732003",
            "telephone_number": "708-730-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "KEITH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-13",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036-070902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kwilliams206341@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "100 W 162nd St",
            "city": "South Holland",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604732003",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "100 W 162nd St",
            "city": "South Holland",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604732003",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in South Holland, IL

Sources for this page

Verify at the official NPI Registry.