Mark Willis, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

57490 Issued in ID

Practice address

1350 Cedar Lake Rd
Pocatello, ID 83204-4946

Phone

(208) 705-2575

Fax

(208) 203-1348

NPI assigned

Jan 3, 2018

Last updated

May 18, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

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

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Optimum Health PLLCGroup PAC ID 1153656590, 9 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Eden Home Health -Idahofalls Home health agency, Idaho Falls, ID, CCN 137119
• Symbii Home Health Home health agency, Chubbuck, ID, CCN 137110
• Heritage Home Health Home health agency, Pocatello, ID, CCN 137117
• Portneuf Medical Center Hospital, Pocatello, ID, CCN 130028
• Power County Hospital District Hospital, American Falls, ID, CCN 131304

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Optimum Health, PLLC

  • Emergency Medicine Physician
  • Pocatello, ID
  • NPI 1306401575
  Medicare reassignment Care Compare group NPD
• Rocky Mountain Physician Group LLC

  • Emergency Medicine Physician
  • Pocatello, ID
  • NPI 1851808133
  Medicare reassignment NPD
• Willis Health Care PLLC

  • Family Nurse Practitioner
  • Pocatello, ID
  • NPI 1447847538
  Authorized official Same address or phone
• Pebble Creek Emergency Physicians PLLC

  • Emergency Medicine Physician
  • Pocatello, ID
  • NPI 1386019784
  NPD (past)

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

• Eden Home Health of Idaho Falls, LLC

  dba Eden Home Health

  • Home Health Agency
  • Idaho Falls, ID
  • NPI 1649683582
  Care Compare affiliation
• Heritage Home Health LLC

  • Home Health Agency
  • Pocatello, ID
  • NPI 1396074027
  Care Compare affiliation
• Pocatello Hospital LLC

  dba Portneuf Rehabilitation Center

  • Rehabilitation Hospital Unit
  • Pocatello, ID
  • NPI 1144262114
  Care Compare affiliation
• Pocatello Hospital LLC

  dba Portneuf Medical Center

  • General Acute Care Hospital
  • Pocatello, ID
  • NPI 1790751055
  Care Compare affiliation
• Power County Hospital District

  • Critical Access Hospital
  • American Falls, ID
  • NPI 1609874932
  Care Compare affiliation
• Whitewater Healthcare LLC

  dba Symbii Home Health

  • Home Health Agency
  • Chubbuck, ID
  • NPI 1477177921
  Care Compare affiliation

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

{
    "created_epoch": "1514937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621296000000",
    "number": "1154838886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 CEDAR LAKE RD",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832044946",
            "telephone_number": "208-705-2575",
            "fax_number": "208-203-1348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 CEDAR LAKE RD",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832044946",
            "telephone_number": "208-705-2575",
            "fax_number": "208-203-1348"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "777 Hospital Way",
            "address_purpose": "LOCATION",
            "city": "Pocatello",
            "state": "ID",
            "postal_code": "832015175",
            "country_code": "US",
            "telephone_number": "208-239-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "MARK",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-01-03",
        "last_updated": "2021-05-18",
        "certification_date": "2021-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "57490",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul Scott Williams, DDS
• Sy Williams, L.C.S.W.
• Matthew E Williamson, D.O.
• Willis Health Care PLLC
• Gary Howard Willis II, O.T.
• Sara Willis
• Willow Counseling & Consulting LLC (Willow Counseling & Consulting)
• Silas Angier Wills Jr., MD
• Teri Lee Wilske, LSW
• Jessica Michelle Wilson-Lucero, ED.S, NCSP

• Family Nurse Practitioner in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Family Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 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.
• 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.