Active NPI
William Vidal Caicedo, FNP-C
- Family Nurse Practitioner
- Middleton, TN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 17787
- Practice address
- 101 Main St N
Middleton, TN 38052-3433 - Phone
- (731) 472-2147
- Fax
- (731) 472-2148
- NPI assigned
- Jul 13, 2013
- Last updated
- Feb 8, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 17787 | TN | Primary |
Addresses
Primary practice location
101 Main St N
Middleton, TN 38052-3433
Mailing address
101 Main St N
Middleton, TN 38052-3433
Phone (731) 472-2147
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2013
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
101 Main St N
Middleton, TN 38052-3433
Phone (731) 472-2147
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Family Medical Center | Family | Current | Accepting new patients |
| Professional Imaging of Tennessee | Past | Accepting new patients |
Locations
101 Main St N
Middleton, TN 38052
Phone (731) 472-2147
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/JDHGDD/Endpoint/JDHGDD
Ownership & related parties
All facility ownership & control disclosures 1
Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.
| Facility | Type | Role | Since |
|---|---|---|---|
| Advanced Family Medical Center | Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Corporate Officer (100%) Operational/Managerial Control (100%) |
Jun 1, 2018 Jun 1, 2018 Jun 1, 2018 |
Owned or controlled facilities with NPI records 1
Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.
-
- Rural Health Clinic/Center
- Middleton, TN
- NPI 1467957126
5% Or Greater Direct Ownership Interest, Corporate Officer, Operational/Managerial Control
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.
-
- Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
- Somerville, TN
- NPI 1073569901
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba West Tennessee Healthcare Bolivar Hospital
- Critical Access Hospital
- Bolivar, TN
- NPI 1518957950
-
- General Acute Care Hospital
- Jackson, TN
- NPI 1093705428
-
- Home Health Agency
- Jackson, TN
- NPI 1932355997
-
- General Acute Care Hospital
- Corinth, MS
- NPI 1699756445
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1373673600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1549584000000",
"number": "1851732259",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 MAIN ST N",
"city": "MIDDLETON",
"state": "TN",
"postal_code": "380523433",
"telephone_number": "731-472-2147",
"fax_number": "731-472-2148"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 MAIN ST N",
"city": "MIDDLETON",
"state": "TN",
"postal_code": "380523433",
"telephone_number": "731-472-2147",
"fax_number": "731-472-2148"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAICEDO",
"first_name": "WILLIAM",
"middle_name": "VIDAL",
"name_prefix": "Mr.",
"credential": "FNP-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-07-13",
"last_updated": "2019-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "TN",
"license": "17787",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Middleton, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.