John Julius Willsen, M.D.

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

License

G36877 Issued in CA

Practice address

1199 Delbon Ave
Suite2
Turlock, CA 95382-2015

Phone

(209) 668-3063

Fax

(209) 668-4992

NPI assigned

Oct 29, 2006

Sex

Male

Sole proprietor

Yes

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 CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299
  Medicare reassignment NPD
• Permanente Medical Group, Inc

  • Clinical Medical Laboratory
  • San Jose, CA
  • NPI 1497971584
  NPD

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

{
    "created_epoch": "1162080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644537600000",
    "number": "1053497347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1199 DELBON AVE",
            "address_2": "SUITE2",
            "city": "TURLOCK",
            "state": "CA",
            "postal_code": "953822015",
            "telephone_number": "209-668-3063",
            "fax_number": "209-668-4992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1199 DELBON AVE",
            "address_2": "SUITE2",
            "city": "TURLOCK",
            "state": "CA",
            "postal_code": "953822015",
            "telephone_number": "209-668-3063",
            "fax_number": "209-668-4992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLSEN",
        "first_name": "JOHN",
        "middle_name": "JULIUS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-29",
        "last_updated": "2022-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "CA",
            "license": "G36877",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4601 Dale Road",
            "city": "Modesto",
            "state": "CA",
            "country_code": "US",
            "postal_code": "95356",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Weston Lange
• Ashley Janelle Whitmire
• Aurora Wiley
• William Derek Williams, PTA
• Matthew Aaron Williamson, PA
• Elisabeth Mellie Wilson, MFT
• Kendyl Catherine Wilson, MSCPT
• Thomas Ian Wilson, M.D,
• Richard Mark Winkler, M.D.
• Allison Wisdom

• Procedural Dermatology Physician in Turlock, CA
• Providers in Turlock, CA by specialty
• Procedural Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.