Adelaide Willis, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A44131 Issued in CA

Practice address

1500 W West Covina Pkwy
West Covina, CA 91790-2708

Phone

(626) 960-8614

Fax

(626) 960-8624

NPI assigned

May 5, 2006

Last updated

Apr 28, 2011By the provider in NPPES

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

Other identifiers 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

Specialty

Family Practice

Education

Other, 1981

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Mayflower Medical Group IncGroup PAC ID 6901804350, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: adelaide.willis.p1@direct.lakeside.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mayflower Medical Group, Inc.

  • Internal Medicine Physician
  • West Covina, CA
  • NPI 1003188160

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Mayflower Medical Group, Inc.

  • Family Medicine Physician
  • Covina, CA
  • NPI 1932146370
  NPD
• Emanate Health Medical Center

  dba Citrus Valley Medical Center Queen Of the Valley Campus

  • General Acute Care Hospital
  • West Covina, CA
  • NPI 1063441293
  NPD (past)
• Lakeside Medical Associates, a Medical Group, Inc.

  dba Lakeside Community Healthcare Medical Group

  • Hospitalist Physician
  • Glendale, CA
  • NPI 1932129434

  Family Medicine

  NPD (past)

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303948800000",
    "number": "1073561346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 W WEST COVINA PKWY",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917902708",
            "telephone_number": "626-960-8614",
            "fax_number": "626-960-8624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 W WEST COVINA PKWY",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917902708",
            "telephone_number": "626-960-8614",
            "fax_number": "626-960-8624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "ADELAIDE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-05",
        "last_updated": "2011-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A44131",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A441310",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wildon Lin MD, Inc
• Treneta Loraine Wilkes
• Betty Williams
• Cayla Williams
• William Tenere Williams, MD
• Wilshire Oncology Medical Group, Inc.
• Wilshire Oncology Medical Group, Inc.
• Mary Jane Lim Wilson, FNP
• Sone-Seere A Wilson, MD
• Samuel Winkler

• Family Medicine Physician in West Covina, CA
• Providers in West Covina, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2011; 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.