NPIMap

Individual provider Active NPI

Jessica Ann Williams, DO

  • Family Medicine Physician
  • Upland, IN
National Provider Identifier
1992332712
Registry record updated Oct 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
02006716A Issued in IN
Practice address
1809 S Main St
Upland, IN 46989-9257
Phone
(765) 770-0650
Fax
(765) 770-0652
NPI assigned
Mar 23, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 17, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 02006716A IN Primary

Addresses

Primary practice location

1809 S Main St
Upland, IN 46989-9257

Mailing address

250 N Shadeland Ave
Indianapolis, IN 46219-4959

Other identifiers 2

IdentifierTypeStateIssuer
300039089MedicaidIN
M22404301OtherINMEDICARE PTAN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jwilliams@direct.iuhealth.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20230629001990 IN Practitioner - Family Practice 2567884984 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Iu Health Medical Group LLCGroup PAC ID 9638617913, 4,382 clinicians
Indiana University Health Ball Memorial Physicians IncGroup PAC ID 9537072640, 286 clinicians

Practice addresses (Care Compare)

1701 N Senate Blvd
Indianapolis, IN 46202-1239
Phone (888) 484-3258

1809 S Main St
Upland, IN 46989-9257
Phone (765) 288-1292

Hospital & facility affiliations

  • Elara Caring Home health agency, Kokomo, IN, CCN 157586
  • Hearts With Integrity Home health agency, Hartford City, IN, CCN 157599
  • Angels of Mercy Homecare Home health agency, Marion, IN, CCN 157554
  • Indiana University Health Ball Memorial Hospital Hospital, Muncie, IN, CCN 150089
  • Marion General Hospital Hospital, Marion, IN, CCN 150011
  • The Orthopaedic Hospital of Lutheran Health Networ Hospital, Ft Wayne, IN, CCN 150168

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
02006716AINMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Indiana University Health Ball Memorial Physicians, Inc. Family Medicine CurrentSince Aug 1, 2023 Accepting new patients
Iu Health Medical Group, LLC Past Accepting new patients
Indiana University Health Ball Memorial Physicians, Inc. Past Accepting new patients

Locations

3832 Solutions Ctr
Chicago, IL 60677

250 N Shadeland Ave
Indianapolis, IN 46219
Phone (317) 948-9174

221 N Celia Ave
Muncie, IN 47303
Phone (765) 747-3141

1809 S Main St
Upland, IN 46989
Phone (765) 660-7520

1809 S Main St
Ste 100
Upland, IN 46989
Phone (765) 770-0650

Interoperability endpoints

  • Direct secure messaging: jwilliams92@direct.iuhealth.org

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 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": "1584921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697500800000",
    "number": "1992332712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N SHADELAND AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1809 S MAIN ST",
            "city": "UPLAND",
            "state": "IN",
            "postal_code": "469899257",
            "telephone_number": "765-770-0650",
            "fax_number": "765-770-0652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "JESSICA",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-03-23",
        "last_updated": "2023-10-17",
        "certification_date": "2023-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02006716A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300039089",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "M22404301",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jwilliams@direct.iuhealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1809 S Main St",
            "city": "Upland",
            "state": "IN",
            "country_code": "US",
            "postal_code": "469899257",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Upland, IN

Sources for this page

Verify at the official NPI Registry.