Jack K Willis Jr., PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA05950 Issued in TX

Practice address

4060 Medical Park Dr # a
Odessa, TX 79765-2233

Phone

(432) 582-2882

Fax

(432) 582-2884

NPI assigned

Oct 21, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Francisco J. Salcido, M.D. P.a.Group PAC ID 7618152281, 8 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Medical Center Hospital Hospital, Odessa, TX, CCN 450132

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/CHJIAD

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.

• Francisco J. Salcido, M.D. P.a.

  • Family Medicine Physician
  • Odessa, TX
  • NPI 1659679926
  Medicare reassignment Care Compare group NPD
• Basin Emergency Physicians PLLC

  • Emergency Medicine Physician
  • Odessa, TX
  • NPI 1831337724
  Medicare reassignment NPD
• Lubbock Primary Care, PLLC

  • Family Medicine Physician
  • Lubbock, TX
  • NPI 1679011621
  Medicare reassignment NPD
• Sentinel Medical Group PLLC

  • Medical Physician Assistant
  • Midland, TX
  • NPI 1689989238
  NPD (past) Authorized official
• MCH Professional Care

  • Multi-Specialty Clinic/Center
  • Odessa, TX
  • NPI 1649391269
  NPD (past)
• Midland Emergency Management PLLC

  • Emergency Medicine Physician
  • Midland, TX
  • NPI 1801889993
  NPD (past)
• Physician Management Services of Texas II, LLC

  • Family Medicine Physician
  • Lubbock, TX
  • NPI 1831750553
  NPD (past)

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

• Ector County Hospital District

  • Federally Qualified Health Center (FQHC)
  • Odessa, TX
  • NPI 1578265302

  Hospital

  Care Compare affiliation
• Ector County Hospital District

  • General Acute Care Hospital
  • Odessa, TX
  • NPI 1740273994
  Care Compare affiliation

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

{
    "created_epoch": "1224547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765497600000",
    "number": "1063664183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4060 MEDICAL PARK DR",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797652233",
            "telephone_number": "432-582-2882",
            "fax_number": "432-582-2884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4060 MEDICAL PARK DR # A",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797652233",
            "telephone_number": "432-582-2882",
            "fax_number": "432-582-2884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "JACK",
        "middle_name": "K",
        "name_suffix": "Jr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-21",
        "last_updated": "2025-12-12",
        "certification_date": "2025-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA05950",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Ryan Williams, L.A.T.
• Cynthia Williams
• Donna Rae Williams, DDS
• Rahfeki S Williams
• David Barry Willingham, M.D.
• Marta Gay Willoughby, MD
• Erin Wilson, MD
• Lloyd Austin Wilson, MA, LPC
• Stephanie Wilson, LVN
• Joshua Caine Wimberley, NRP

• Physician Assistant in Odessa, TX
• Providers in Odessa, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2025; 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.