Kandi Lauren Willis, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

7204 Issued in GA

Practice address

58 Big a Rd
Toccoa, GA 30577-6017

Phone

(706) 827-2607

NPI assigned

Apr 15, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northeast Georgia Physicians Group Urgent Care LLCGroup PAC ID 3274535687, 62 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northeast Georgia Medical Center, Inc Hospital, Gainesville, GA, CCN 110029

Merit-based Incentive Payment System (MIPS)

Final score

88.16 of 100Reported as group

Quality

85.71

Promoting interoperability

100

Improvement activities

40

Cost

74.81

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: kwillis154741@nghs.gadirect.net

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.

• Northeast Georgia Physicians Group Urgent Care LLC

  • Family Medicine Physician
  • Gainesville, GA
  • NPI 1790875037
  Medicare reassignment Care Compare group
• Georgia Emergency Medicine Specialists, PC

  • Emergency Medicine Physician
  • Athens, GA
  • NPI 1316064629
  Medicare reassignment

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

• Northeast Georgia Medical Center, Inc.

  • General Acute Care Hospital
  • Gainesville, GA
  • NPI 1427055821
  Care Compare affiliation

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

{
    "created_epoch": "1397520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674086400000",
    "number": "1013336205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746216",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746216",
            "telephone_number": "770-219-8420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "58 BIG A RD",
            "city": "TOCCOA",
            "state": "GA",
            "postal_code": "305776017",
            "telephone_number": "706-827-2607"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "485 Highway 29 N",
            "address_purpose": "LOCATION",
            "city": "Athens",
            "state": "GA",
            "postal_code": "306015583",
            "country_code": "US",
            "telephone_number": "706-353-9300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1199 Prince Ave",
            "address_purpose": "LOCATION",
            "city": "Athens",
            "state": "GA",
            "postal_code": "306062797",
            "country_code": "US",
            "telephone_number": "706-475-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "KANDI",
        "middle_name": "LAUREN",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-15",
        "last_updated": "2023-01-19",
        "certification_date": "2023-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "7204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kwillis154741@nghs.gadirect.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "58 Big A Rd",
            "city": "Toccoa",
            "state": "GA",
            "country_code": "US",
            "postal_code": "305776017",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Rebecca Leigh Watson, NP
• Shelia Deanne Westmoreland, LPC004909
• Joseph Hill Wilbanks Sr., DDS PC
• Wilkinson Personal Care Home
• Stephen George Will Jr.
• Melissa R. Withers, HAD
• Shandrika Wofford
• Bryan Gerald Wood, RPH
• David William Wood
• Morgan Wood, MD

• Physician Assistant in Toccoa, GA
• Providers in Toccoa, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.