Active NPI
Michael L Williams, D.O.
- Family Medicine Physician
- O'Fallon, MO
National Provider Identifier
1851353247
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 2005036219
- Practice address
- Ultra Wellness Medical, LLC
3026 Winghaven Blvd.
O'Fallon, MO 63368 - Phone
- (636) 333-9820
- Fax
- (636) 228-0039
- NPI assigned
- Apr 3, 2006
- Last updated
- Sep 23, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 20A18065 | CA | |
| Family Medicine Physician | 207Q00000X | 2005036219 | IL | Primary |
Addresses
Primary practice location
Ultra Wellness Medical, LLC
3026 Winghaven Blvd.
O'Fallon, MO 63368
Mailing address
3026 Winghaven Blvd.
O'Fallon, MO 63368
Phone (636) 333-9820
Other practice location 1
400 Medical Plz Ste 200
Lake St Louis, MO 63367-1417
Phone (636) 625-2662
Other practice location 2
7421 Highway N
Dardenne Prairie, MO 63368-7014
Phone (636) 561-5699
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200202505 | Medicaid | MO |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mwilliams20170@direct-ehr-ssmhc.com | Direct | |
| FHIR URL | https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ | Other |
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: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Nov 17, 2022 through Nov 17, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20A18065 | CA | MD | Family Medicine Physician |
| 2005036219 | IL | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144022400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663891200000",
"number": "1851353247",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3026 WINGHAVEN BLVD.",
"city": "O'FALLON",
"state": "MO",
"postal_code": "63368",
"telephone_number": "636-333-9820",
"fax_number": "636-228-0039"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "ULTRA WELLNESS MEDICAL, LLC",
"address_2": "3026 WINGHAVEN BLVD.",
"city": "O'FALLON",
"state": "MO",
"postal_code": "63368",
"telephone_number": "636-333-9820",
"fax_number": "636-228-0039"
}
],
"practiceLocations": [
{
"address_1": "400 Medical Plz Ste 200",
"address_purpose": "LOCATION",
"city": "Lake St Louis",
"state": "MO",
"postal_code": "633671417",
"country_code": "US",
"telephone_number": "636-625-2662",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "7421 Highway N",
"address_purpose": "LOCATION",
"city": "Dardenne Prairie",
"state": "MO",
"postal_code": "633687014",
"country_code": "US",
"telephone_number": "636-561-5699",
"fax_number": "636-669-2401",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILLIAMS",
"first_name": "MICHAEL",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-03",
"last_updated": "2022-09-23",
"certification_date": "2022-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "20A18065",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "2005036219",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200202505",
"state": "MO"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mwilliams20170@direct-ehr-ssmhc.com",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "mwilliams20170@direct-ehr-ssmhc.com",
"address_1": "400 Medical Plz Ste 200",
"city": "Lake St Louis",
"state": "MO",
"country_code": "US",
"postal_code": "633671417",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
"affiliation": "N",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "FHIR API",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CCD",
"address_1": "400 Medical Plz Ste 200",
"city": "Lake St Louis",
"state": "MO",
"country_code": "US",
"postal_code": "633671417",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in O'Fallon, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.