NPIMap

Individual provider Active NPI

Scott Gwilliam, FNP-BC

  • Family Nurse Practitioner
  • Lafayette, CA
National Provider Identifier
1942892815
Registry record updated Feb 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95016644 Issued in CA
Practice address
3 Burr CT
Lafayette, CA 94549-5504
Phone
(801) 367-1318
NPI assigned
Feb 10, 2021
Last updated
Feb 10, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95016644 CA Primary

Addresses

Primary practice location

3 Burr CT
Lafayette, CA 94549-5504

Mailing address

3 Burr CT
Lafayette, CA 94549-5504
Phone (801) 367-1318

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20210714002748 CA Practitioner - Nurse Practitioner 3274935135 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

22044 Cedar Rd
Sonora, CA 95370
Phone (209) 532-0034

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
47.39 of 100Reported as group
Quality
13.78
Promoting interoperability
0
Improvement activities
40
Cost
81.09

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95016644CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Tuolumne Me-Wuk Indian Health Center, Inc. CurrentSince Apr 3, 2023 Accepting new patients
Tuolumne Mewuk Indian Health Center, Inc Family CurrentSince Apr 3, 2023 Accepting new patients
Integrated Pain Management Medical Group, Inc. CurrentSince Jul 1, 2021 Accepting new patients

Locations

4530 Balfour Rd
Brentwood, CA 94513
Phone 9256919806151

999 N Tustin Ave
Ste 201
Santa Ana, CA 92705
Phone (714) 975-7950

18880 Cherry Valley Blvd
Tuolumne, CA 95379
Phone (209) 928-5400

450 N Wiget Ln
Walnut Creek, CA 94598
Phone (925) 413-4960

Interoperability endpoints

  • Direct secure messaging: scott.gwilliam.p1@direct.tmwihc.nextgenshare.com

Organizations & group practices 3

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.

Hospital & facility affiliations 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1612915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612915200000",
    "number": "1942892815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 BURR CT",
            "city": "LAFAYETTE",
            "state": "CA",
            "postal_code": "945495504",
            "telephone_number": "801-367-1318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 BURR CT",
            "city": "LAFAYETTE",
            "state": "CA",
            "postal_code": "945495504",
            "telephone_number": "801-367-1318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GWILLIAM",
        "first_name": "SCOTT",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-02-10",
        "last_updated": "2021-02-10",
        "certification_date": "2021-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95016644",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, CA

Sources for this page

Verify at the official NPI Registry.