NPIMap

Individual provider Active NPI

Jeffrey R Williamson, DO

  • Family Medicine Physician
  • Rockford, MI
National Provider Identifier
1881641165
Registry record updated Jan 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
JW011762 Issued in MI
Practice address
6785 Myers Lake Ave NE
Rockford, MI 49341
Phone
(616) 884-5191
Fax
(616) 884-5192
NPI assigned
May 30, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 27, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X JW011762 MI Primary

Addresses

Primary practice location

6785 Myers Lake Ave NE
Rockford, MI 49341

Mailing address

PO Box 260
Rockford, MI 49341
Phone (616) 884-5191

Other identifiers 1

IdentifierTypeStateIssuer
48103028MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050304000538 MI Practitioner - Family Practice 5294789053 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Midwestern University, Chicago College of Osteopathic Med, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Center for Physical Rehabilitation IncGroup PAC ID 6901717768, 352 clinicians
Center for Physical Rehabilitation and Therapy LPGroup PAC ID 0941513303, 365 clinicians
Jeffrey R Williamson DO PCGroup PAC ID 4082632617, 2 clinicians

Practice addresses (Care Compare)

5060 Cascade Rd
Suite a
Grand Rapids, MI 49546-3808

5060 Cascade Rd SE
Suite a
Grand Rapids, MI 49546-3808

6785 Myers Lake Ave NE
Rockford, MI 49341-7416

6785 Myers Lake NE Ave B
Rockford, MI 49341-7415
Phone (616) 884-5191

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
JW011762MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Metropolitan Hospital CurrentSince Jan 1, 2000 Accepting new patients
Metropolitan Hospital Family Medicine CurrentSince Jan 1, 2000 Accepting new patients
Jeffrey R Williamson DO PC Family Medicine CurrentSince Apr 1, 2005 Accepting new patients
Elder Care of West Michigan PLLC CurrentSince Apr 15, 2019 Accepting new patients
West Michigan Rehab PLLC Past Accepting new patients
White Pine Family Medicine PLLC Past Accepting new patients
Spectrum Health Kelsey Past Accepting new patients
Ambulatory United Past Accepting new patients
White Pine Family Medicine Past Accepting new patients
Mobile Physician Services Inc. Past Accepting new patients

Locations

261 N Main St
Cedar Springs, MI 49319
Phone (616) 287-5637

1925 Breton Rd SE
Grand Rapids, MI 49506
Phone (616) 252-4100

6785 Myers Lake Ave NE
Ste B
Rockford, MI 49341
Phone (616) 884-5191

6785 Myers Lake Ave NE
Rockford, MI 49341
Phone (616) 366-4234

781 36th St SE
Wyoming, MI 49548
Phone (616) 252-4100

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HGAFAA

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1148947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580083200000",
    "number": "1881641165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 260",
            "city": "ROCKFORD",
            "state": "MI",
            "postal_code": "49341",
            "telephone_number": "616-884-5191",
            "fax_number": "616-884-5192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6785 MYERS LAKE AVE NE",
            "city": "ROCKFORD",
            "state": "MI",
            "postal_code": "49341",
            "telephone_number": "616-884-5191",
            "fax_number": "616-884-5192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMSON",
        "first_name": "JEFFREY",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-30",
        "last_updated": "2020-01-27",
        "certification_date": "2020-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "JW011762",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "48103028",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, MI

Sources for this page

Verify at the official NPI Registry.