Rudolph Willis, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

25MA04275000 Issued in NJ

Practice address

12 Krotik PL
Irvington Emergent Care and Rehabilitation Center Inc.
Irvington, NJ 07111-1708

Phone

(973) 373-3000

NPI assigned

Mar 31, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

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

Rutgers R W Johnson Medical School (Cam/New Bruns/Pisc), 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Meritus Medical Center IncGroup PAC ID 7113811795, shared by 8 NPIs, 730 clinicians

Medical Associates of Englewood PCGroup PAC ID 1355512252, 538 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Englewood Hospital and Medical Center Hospital, Englewood, NJ, CCN 310045

Merit-based Incentive Payment System (MIPS)

Final score

96.09 of 100Reported as apm

Quality

86.89

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Medical Associates of Englewood, PC

  • Internal Medicine Physician
  • Englewood, NJ
  • NPI 1952681918
  Medicare reassignment Care Compare group NPD
• Irvington Emergent Care

  • Specialist
  • Irvington, NJ
  • NPI 1578808952
  NPD Authorized official
• Irvington Mobile Imaging

  • Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
  • Warren, NJ
  • NPI 1598490294
  NPD Authorized official
• Newark Beth Israel Medical Center Inc

  • General Acute Care Hospital
  • Newark, NJ
  • NPI 1215027966
  NPD (past)

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

• Englewood Hospital and Medical Center

  • General Acute Care Hospital
  • Englewood, NJ
  • NPI 1083612881
  Care Compare affiliation

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

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773100800000",
    "number": "1104887819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 KROTIK PL",
            "address_2": "IRVINGTON EMERGENT CARE AND REHABILITATION CENTER INC.",
            "city": "IRVINGTON",
            "state": "NJ",
            "postal_code": "071111708",
            "telephone_number": "973-373-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 KROTIK PL",
            "address_2": "IRVINGTON EMERGENT CARE AND REHABILITATION CENTER INC.",
            "city": "IRVINGTON",
            "state": "NJ",
            "postal_code": "071111708",
            "telephone_number": "973-373-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "RUDOLPH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-31",
        "last_updated": "2026-03-10",
        "certification_date": "2026-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NJ",
            "license": "MA42750",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MA04275000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0887307",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tamika Wheeler, LPC, LCADC
• Tiffany White
• Kenazia Amber Whyte, LICENSED MT
• Tameka Williams- Damon, LPN
• Harquan Maurice Williams Jr.
• Craig Harold Wilson, D.D.S.
• Edna Wireko, PMHNP
• With US in Mind Incorporated
• Dina Yadgarova
• Irene Asante Yeboah

• Family Medicine Physician in Irvington, NJ
• Providers in Irvington, NJ by specialty
• Family Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2026; 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.