Roderick Jerome Williams, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

AP60853251 Issued in WA

Practice address

600 Broadway St
Longview, WA 98632-3256

Phone

(360) 414-2236

NPI assigned

Aug 10, 2017

Last updated

Oct 20, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in ND, CA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Clarity-James Medical Services CorpGroup PAC ID 2668886813, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/25478/brand/2/csg/1/fhir/r4
• Direct secure messaging: roderick.williams.1@25478.direct.athenahealth.com
• Direct secure messaging: rwilliams370385@direct.peacehealth.org

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.

• Clarity-James Medical Services Corp

  • Psychiatry Physician
  • San Rafael, CA
  • NPI 1972192953
  Medicare reassignment Care Compare group NPD
• PSJ Acquisition LLC

  dba Prairie St John's

  • Psychiatric Hospital
  • Fargo, ND
  • NPI 1679709802
  Medicare reassignment NPD
• PSJ Acquisition LLC

  dba Prairie St. John's

  • Psychologist
  • Fargo, ND
  • NPI 1720454267
  NPD

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

{
    "created_epoch": "1502323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539993600000",
    "number": "1861917882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3230 SETER PKWY S APT 201",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581047822",
            "telephone_number": "601-335-5988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 BROADWAY ST",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986323256",
            "telephone_number": "360-414-2236"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "510 4th St S",
            "address_purpose": "LOCATION",
            "city": "Fargo",
            "state": "ND",
            "postal_code": "58103",
            "country_code": "US",
            "telephone_number": "701-476-7200 x208",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "RODERICK",
        "middle_name": "JEROME",
        "name_prefix": "Mr.",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-10",
        "last_updated": "2018-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "ND",
            "license": "R44293",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP60853251",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daphne Williams
• Garrett R Williams, CPSS
• June Kathryn Williams
• Lori Lynn Williams, LCSW
• Noah Williams
• Tracey Lynne Williams
• Jackson Wilshire, M.A., LPC-INT
• Angela Marie Wilson, EFDA
• Candace Wilson
• Christine Wilson, PHARMD

• Psychiatric/Mental Health Nurse Practitioner in Longview, WA
• Providers in Longview, WA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2018; 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.
• 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.

Verify at the official NPI Registry.