Tyler Davis Willson

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0101276919 Issued in VA

Practice address

1314 Peters Creek Rd NW
Roanoke, VA 24017-2500

Phone

(540) 562-5700

Fax

(540) 562-4278

NPI assigned

Apr 1, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

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

Virginia Tech Carilion School of Medicine, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Carilion Medical CenterGroup PAC ID 9830096585, 956 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Carilion Home Care Services - Roanoke Home health agency, Roanoke, VA, CCN 497258
• Carilion Medical Center Hospital, Roanoke, VA, CCN 490024

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: twillson83006@direct.carilionclinic.org

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.

• Carilion Medical Center

  • Multi-Specialty Clinic/Center
  • Roanoke, VA
  • NPI 1730123472
  Medicare reassignment Care Compare group NPD
• Carilion Medical Center

  • Durable Medical Equipment & Medical Supplies
  • Hardy, VA
  • NPI 1073324810
  NPD
• Carilion Medical Center

  • General Acute Care Hospital
  • Roanoke, VA
  • NPI 1033102942
  NPD (past)

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

• Carilion Medical Center

  • General Acute Care Hospital
  • Roanoke, VA
  • NPI 1033102942
  Care Compare affiliation
• Carilion Medical Center

  • Home Health Agency
  • Roanoke, VA
  • NPI 1073506002
  Care Compare affiliation

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

{
    "created_epoch": "1585699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685577600000",
    "number": "1093343279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 S JEFFERSON ST STE 1006",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240111713",
            "telephone_number": "540-224-5352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1314 PETERS CREEK RD NW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240172500",
            "telephone_number": "540-562-5700",
            "fax_number": "540-562-4278"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1906 Belleview Ave SE",
            "address_purpose": "LOCATION",
            "city": "Roanoke",
            "state": "VA",
            "postal_code": "240141838",
            "country_code": "US",
            "telephone_number": "540-981-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLSON",
        "first_name": "TYLER",
        "middle_name": "DAVIS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-01",
        "last_updated": "2023-06-01",
        "certification_date": "2023-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101276919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Willis, LPC
• Rhonda L Willoughby-Nunley, PA
• Charles J Wills, LPC
• Gabrielle Evelyn Willson
• Timothy R Willson, D.C.
• Claire Wilsey, PA
• Wilson Chiropractic Clinic
• Adrian Shawn Reid Wilson, PHARMD
• Andrew Michael Wilson, PTA
• Autumn Simms Wilson, LPC

• Family Medicine Physician in Roanoke, VA
• Providers in Roanoke, VA by specialty
• Family Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2023; 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.