FONTAINE WILLIAMS – Gerontology Nurse Practitioner, NPI 1467857896
Gerontology Nurse Practitioner
Main info
Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for FONTAINE WILLIAMS
6680 POE AVE STE 200
DAYTON, OH 454142855
Phone: (937) 293-1622
Type: Mailing
2350 MIAMI VALLEY DR STE 500
CENTERVILLE, OH 454594780
Phone: (937) 293-1622
Fax: (937) 245-6308
Type: Location
3170 KETTERING BLVD BLDG B3
MORAINE, OH 454391924
Phone: (937) 991-3186
Fax: (937) 223-9811
Type: Mailing
9000 N MAIN ST STE 101
ENGLEWOOD, OH 454151184
Phone: (937) 832-2425
Fax: (937) 832-8495
Type: Location
2222 Philadelphia Dr
Dayton, OH 454061813
Phone: (937) 734-5567
Type: Location
1 Wyoming St
Dayton, OH 454092722
Phone: (937) 208-8000
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2017-02-14
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20170214002079 | I | Nurse Practitioner | OH | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 45414)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | OH | |
| Nurse Practitioner | OH | |
| - | OH | |
| Mental Health Counselor | OH | |
| Nurse Practitioner | OH | |
| Mental Health Counselor | OH | |
| - | CA | |
| Mental Health Counselor | OH | |
| Addiction Medicine | OH | |
| Physician Assistant | OH |
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