Active NPI
Crystal Willis
- Attendant Care Provider
- Greenwood, IN
National Provider Identifier
1093575102
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Attendant Care Provider
- License
- 300079808
- Practice address
- 1263 Odell LN
Greenwood, IN 46143-7966 - Phone
- (317) 794-6979
- NPI assigned
- Mar 19, 2024
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Attendant Care Provider | 3747A0650X | 300079808 | IN | Primary |
Addresses
Primary practice location
1263 Odell LN
Greenwood, IN 46143-7966
Mailing address
1263 Odell LN
Greenwood, IN 46143-7966
Phone (317) 794-6979
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 300079808 | IN | MD | Attendant Care Provider |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ida'S Home Care LLC | Attendant Care Provider | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- In Home Supportive Care Agency
- Greenwood, IN
- NPI 1952147225
Attendant Care Provider
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1710806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1710806400000",
"number": "1093575102",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1263 ODELL LN",
"city": "GREENWOOD",
"state": "IN",
"postal_code": "461437966",
"telephone_number": "317-794-6979"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1263 ODELL LN",
"city": "GREENWOOD",
"state": "IN",
"postal_code": "461437966",
"telephone_number": "317-794-6979"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "CRYSTAL",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-03-19",
"last_updated": "2024-03-19",
"certification_date": "2024-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "3747A0650X",
"taxonomy_group": "",
"desc": "Technician, Attendant Care Provider",
"state": "IN",
"license": "300079808",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greenwood, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.