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Deactivated NPI 1083014633 Deactivated / Inactive NPI Male Practitioner

Jack Williams

Community Health Worker • Eugene, OR

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Jack Williams has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date September 02, 2014
NPI Deactivation Date October 09, 2025
Total Practice Duration ~11 Years of Practice (2014 – 2025)

Professional Overview & Biography Verified Profile Summary

Jack Williams was a registered Community Health Worker practicing in Eugene, OR. Throughout an active medical career spanning 11 years, Jack Williams provided care at the practice location at 149 W 12TH AVE until profile deactivation on 2025-10-09.

Practice Location & Contact Primary Location

Practice Address

149 W 12th Ave

Eugene, OR 974016215

Telephone 5413440031
Fax 5413440772

Specialty Benchmarks & Practice Insights

Comparative analytics for Community Health Worker in Eugene, OR

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 40.0 Yrs
Regional Practice Density
59 Specialists

Practicing in Eugene, OR (1230 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Community Health Worker Primary Specialty

NUCC Taxonomy Code: 172V00000X

Community health workers (CHW) are lay members of communities who work either for pay or as volunteers in association with the local health care system in both urban and rural environments and usually share ethnicity, language, socioeconomic status and life experiences with the community members they serve. They have been identified by many titles such as community health advisors, lay health advocates, "promotores(as), outreach educators, community health representatives, peer health promoters, and peer health educators. CHWs offer interpretation and translation services, provide culturally appropriate health education and information, assist people in receiving the care they need, give informal counseling and guidance on health behaviors, advocate for individual and community health needs, and provide some direct services such as first aid and blood pressure screening. Some examples of these practitioners are Community Health Aides or Practitioners established under 25 USC 1616 (l) under HHS, Indian Health Service, Public Health Service.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

6 Associated Practitioners
Lisa Spring , CADC II, QMHA-1

Counselor - Addiction (Substance Use Disorder)

NPI 1528106531

CADCII, QMHA1

Brian Nelson , CADC I

Counselor - Addiction (Substance Use Disorder)

NPI 1538516307

CADCI

Jonathan Smith , CADC II

Counselor - Addiction (Substance Use Disorder)

NPI 1548567688

CADCII

Tonya Pierson , CADC1

Counselor - Addiction (Substance Use Disorder)

NPI 1669913414
Camm Clark , LCSW

Social Worker - Clinical

NPI 1699118935

Licensed Clinical Social Worker

Sarah Harris , BA, CASC I

Counselor - Addiction (Substance Use Disorder)

NPI 1992145296

Bachelor of Arts, CASCI

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

13 Historical Events
⚠️
NPI Profile Deactivated October 09, 2025

Record deactivated on October 09, 2025

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Medical Taxonomy / Specialty Registered (Primary Specialty) August 24, 2025

Peer Specialist

NPI Profile Active April 04, 2017

NPI status registered as active in NPPES database

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Updated Practice Location April 04, 2017

Registered at 687 CHESHIRE AVE, EUGENE, OR 974025060 (Tel: 5417624409)

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Updated Business Mailing Address April 04, 2017

Registered at 687 CHESHIRE AVE, EUGENE, OR 974025060 (Tel: 5417624409)

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Provider Name / Credentials Updated April 04, 2017

Recorded as JACK WILLIAMS

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) April 04, 2017

Community Health Worker

NPI Profile Active September 02, 2014

NPI status registered as active in NPPES database

📍
Updated Practice Location September 02, 2014

Registered at 149 W 12TH AVE, EUGENE, OR 974016215 (Tel: 5413440031)

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Updated Business Mailing Address September 02, 2014

Registered at 149 W 12TH AVE, EUGENE, OR 974016215 (Tel: 5413440031)

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Provider Name / Credentials Updated September 02, 2014

Recorded as JACK WILLIAMS

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Medical Taxonomy / Specialty Registered (Primary Specialty) September 02, 2014

Community Health Worker

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Initial NPI Registration & Enumeration September 02, 2014

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1083014633
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: September 02, 2014
Last Update: September 02, 2014
Deactivation Date: October 09, 2025

Mailing Address

149 W 12th Ave

Eugene, OR 974016215

Phone: 5413440031

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.