Active NPI
Randall Matthew Willis, MD
- Sports Medicine (Preventive Medicine) Physician
- Knoxville, TN
National Provider Identifier
1053569145
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Preventive Medicine) Physician
- License
- 14380
- Practice address
- 207 Brechin LN
Knoxville, TN 37909-2165 - Phone
- (865) 406-4044
- NPI assigned
- Sep 3, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Preventive Medicine) Physician | 2083S0010X | 14380 | TN | Primary |
Addresses
Primary practice location
207 Brechin LN
Knoxville, TN 37909-2165
Mailing address
5508 Kingston Pike
Suite 150
Knoxville, TN 37919-5048
Phone (865) 584-6464
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14380 | TN | MD | Sports Medicine (Preventive Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1220400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1220400000000",
"number": "1053569145",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5508 KINGSTON PIKE",
"address_2": "SUITE 150",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379195048",
"telephone_number": "865-584-6464"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "207 BRECHIN LN",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379092165",
"telephone_number": "865-406-4044"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "RANDALL",
"middle_name": "MATTHEW",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-09-03",
"last_updated": "2008-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "2083S0010X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Sports Medicine",
"state": "TN",
"license": "14380",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Knoxville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.