Individual provider Active NPI

Virginia Lynn Willis, LCSW

  • Clinical Social Worker
  • Paragould, AR
National Provider Identifier
1174839641
Registry record updated May 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6221-C Issued in AR
Practice address
1101 Morgan St
Suite 8
Paragould, AR 72450-3949
Phone
(870) 335-9483
Fax
(870) 335-9487
NPI assigned
Aug 23, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 6221-C AR Primary

Addresses

Primary practice location

1101 Morgan St
Suite 8
Paragould, AR 72450-3949

Mailing address

1815 Pleasant Grove Rd
Jonesboro, AR 72401-7870
Phone (870) 933-6886

Other identifiers 2

IdentifierTypeStateIssuer
171642795MedicaidAR
5BA66OtherARBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150814014092 AR Practitioner - Clinical Social Worker 1355656620 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Open Book Wellness Center, LLCGroup PAC ID 9133534902, 8 clinicians

Practice addresses (Care Compare)

517 N 14TH St
Suite 4
Paragould, AR 72450-3550
Phone (870) 365-3881

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Open Book Wellness Center LLC Clinical CurrentSince Apr 4, 2022 Accepting new patients
Families, Inc. of Arkansas Past Accepting new patients

Locations

517 N 14th St
Ste 4
Paragould, AR 72450
Phone (870) 365-3881

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1282521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525824000000",
    "number": "1174839641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1815 PLEASANT GROVE RD",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724017870",
            "telephone_number": "870-933-6886",
            "fax_number": "870-933-9395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 MORGAN ST",
            "address_2": "SUITE 8",
            "city": "PARAGOULD",
            "state": "AR",
            "postal_code": "724503949",
            "telephone_number": "870-335-9483",
            "fax_number": "870-335-9487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "VIRGINIA",
        "middle_name": "LYNN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-23",
        "last_updated": "2018-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AR",
            "license": "6221-C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "171642795",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "5BA66",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Paragould, AR

Sources for this page

Verify at the official NPI Registry.