Kent Willis, D.O.
Individual provider Active NPI Family Medicine Physician · Pleasant Grove, UT
NPI 1114306131 · NPPES record last updated Jul 13, 2018
Key facts
- NPI
- 1114306131
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 10701125-1204 (UT)
- Practice address
- 830 N 2000 W
Pleasant Grove, UT 84062 - Phone
- (801) 756-3511
- NPI assigned
- May 22, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Premier Family Medical
Practice addresses (Care Compare)
830 N 2000
Pleasant Grove, UT 84062-4047
Phone (801) 756-3511
Hospital & facility affiliations
- American Fork Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 12 |
| Removal or shaving of skin growth | 1-10 |
| Skin biopsy | 11 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180711003283 | UT | Practitioner - Family Practice |
1850667007 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15071 | CA | MD | Acupuncturist |
| 10701125-1204 | UT | MD | Hospitalist Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Premier Family Medical | Family Medicine | Current | Accepting new patients |
| Utah Regional Hospitalists LLC | Hospitalist | Current |
Accepting new patients |
| Premier Family Medical - City Center | Family Medicine | Current |
Accepting new patients |
| Premier Family Medical - American Fork | Family Medicine | Current |
Accepting new patients |
| Utah Regional Hospitalists LLC | Hospitalist | Current |
Accepting new patients |
| Premier Family Medical - Saratoga Springs | Family Medicine | Past | Accepting new patients |
Locations
226 N 1100 E
American Fork, UT 84003
Phone (801) 855-3840
3943 E Pony Express Pkwy
Ste 120
Eagle Mountain, UT 84005
Phone (801) 443-1184
680 E Main St
Lehi, UT 84043
Phone (801) 766-0606
275 W 200 N
Lindon, UT 84042
Phone (801) 796-1333
5505 S 900 E
Ste 240
Murray, UT 84117
Phone (801) 406-9601
830 N 2000 W
Pleasant Grv, UT 84062
Phone (801) 756-3511
62 E Thrive Dr
Ste 100
Saratoga Springs, UT 84045
Phone (801) 766-8427
1528 N Commerce Dr
Ste 204
Saratoga Springs, UT 84045
1200 E 3900 S
Slc, UT 84124
Phone (801) 268-7111
1050 E South Temple
Slc, UT 84102
Phone (801) 350-4111
707 E Mill Rd
Ste 303
Vineyard, UT 84059
Phone (801) 224-1300
3580 W 90th S
West Jordan, UT 84088
Phone (801) 263-0810
3460 S Pioneer Pkwy
West Valley City, UT 84120
Phone (801) 964-3111
Interoperability endpoints
- kwillis@pfm.gwaydirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hospitalist Physician | 208M00000X | 10701125-1204 | UT | |
| Family Medicine Physician | 207Q00000X | 10701125-1204 | UT | Yes |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
830 N 2000 W
Pleasant Grove, UT 84062
Mailing address
830 N 2000 W
Pleasant Grove, UT 84062-4047
Phone (801) 756-3511
Other practice location 1
3291 Loma Vista Rd
Ventura, CA 93003-3099
Phone (805) 652-6100
Other practice location 2
5505 S 900 E Ste 240
Murray, UT 84117-7210
Phone (801) 783-5011
Other providers in Pleasant Grove, UT
- Kayla K Williams
- Lashawn Williams
- Melissa Williams
- Sierra Williams
- Eva Jean Willis
- Marshall F Willis
- Willow Therapy Services, LLC
- Willow Tree Recovery, LLC
- Emily Wilson
- Adam Wing
All providers in Pleasant Grove, UT · Family Medicine Physician in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.