Randee Denice Willis, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

13139PA Issued in CA

Practice address

23456 Hawthorne Blvd Ste 100
Torrance, CA 90505-4752

Phone

(310) 540-5272

Fax

(310) 540-7271

NPI assigned

Sep 13, 2006

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

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

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.

• Signify Health Medical Associates of California, PC

  • General Practice Physician
  • San Francisco, CA
  • NPI 1124685169
  Medicare reassignment NPD
• Csi Medical Group

  • MOHS-Micrographic Surgery Physician
  • San Pedro, CA
  • NPI 1871909804
  NPD
• Good Derm, Inc

  dba Good Dermatology

  • Dermatology Physician
  • Torrance, CA
  • NPI 1407474273
  NPD

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635465600000",
    "number": "1073618260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24209 PARK ST",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905056554",
            "telephone_number": "310-373-5022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23456 HAWTHORNE BLVD STE 100",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905054752",
            "telephone_number": "310-540-5272",
            "fax_number": "310-540-7271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "RANDEE",
        "middle_name": "DENICE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-13",
        "last_updated": "2021-10-29",
        "certification_date": "2021-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "13139PA",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "13139PA",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Zacharia Xavier John Williams, DPT
• Ayesha Denice Williamson
• Lanise Pearl Williamson
• Areulius Damond Willis
• Hunter Faith Willis
• Stacey Willis
• Therese Judith Willis, DPT
• Wilson Medical Group, PC (South Bay Behavioral Medicine)
• Angela Michelle Wilson
• Cara Meghan Wilson, M.D.

• Physician Assistant in Torrance, CA
• Providers in Torrance, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2021; 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.