Jon R Willison, DDS

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

00203801 Issued in CO

Practice address

1903 Wilmington Dr Unit 101
Fort Collins, CO 80528-6100

Phone

(970) 568-5255

NPI assigned

Oct 26, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 23, 2016 through Jan 23, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Networks

• NM HMO C-SNP
• CO HMO D-SNP

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

{
    "created_epoch": "1319587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576022400000",
    "number": "1013293760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1903 WILMINGTON DR UNIT 101",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805286100",
            "telephone_number": "970-568-5255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1903 WILMINGTON DR UNIT 101",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805286100",
            "telephone_number": "970-568-5255"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2996 Ginnala Dr Ste 101",
            "address_purpose": "LOCATION",
            "city": "Loveland",
            "state": "CO",
            "postal_code": "805382832",
            "country_code": "US",
            "telephone_number": "970-292-6703",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1950 Bluegrass Cir Ste 120",
            "address_purpose": "LOCATION",
            "city": "Cheyenne",
            "state": "WY",
            "postal_code": "820097363",
            "country_code": "US",
            "telephone_number": "307-222-6665",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLISON",
        "first_name": "JON",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-10-26",
        "last_updated": "2019-12-11",
        "certification_date": "2019-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CO",
            "license": "DEN.00203801",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "WY",
            "license": "1517",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MO",
            "license": "2013042229",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "CO",
            "license": "00203801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "FortCollins",
            "affiliation": "N",
            "address_1": "1903 Wilmington Dr Unit 101",
            "city": "Fort Collins",
            "state": "CO",
            "country_code": "US",
            "postal_code": "805286100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Stacy Williams, R.N.
• Helena Williamson
• Shannon Williamson
• Jamie Willingham
• Winston James Willis
• Erin K. Willits, MD
• Ronda Loreen Willmot, AU.D., CCC-A
• Brant Michael Willoughby, C.O.T.A.
• Willow Collective
• Willow Collective

• Endodontics in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• Endodontics in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.