John M Willis, DO

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

J0366 Issued in TX

Practice address

252 Matlock Rd Ste 130
Mansfield, TX 76063-4295

Phone

(682) 242-8990

Fax

(682) 242-8996

NPI assigned

Apr 20, 2006

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

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

Internal Medicine

Education

University of North Texas HSC, College of Osteopathic Med, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

MedhealthGroup PAC ID 9931001567, 435 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Methodist Mansfield Medical Center Hospital, Mansfield, TX, CCN 670023

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jwillis14067@dm.mhd.com

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Methodist Hospitals of Dallas

  dba Methodist Celina Medical Center

  • General Acute Care Hospital
  • Celina, TX
  • NPI 1073294740

  Corporate Director

  CMS ownership
• Methodist Hospitals of Dallas

  dba Methodist Charlton Medical Center

  • General Acute Care Hospital
  • Dallas, TX
  • NPI 1275592131

  Corporate Director

  CMS ownership

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.

• Medhealth

  dba Methodist Medical Group

  • Family Medicine Physician
  • Dallas, TX
  • NPI 1912957200

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Medhealth

  dba Methodist Medical Group

  • Urgent Care Clinic/Center
  • Grand Prairie, TX
  • NPI 1558762690
  NPD
• Physicians and Allied Health Professionals Group, PA

  • Family Medicine Physician
  • Dallas, TX
  • NPI 1528011814

  Internal Medicine

  NPD (past)

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

• Methodist Hospitals of Dallas

  dba Methodist Mansfield Medical Center

  • General Acute Care Hospital
  • Mansfield, TX
  • NPI 1689629941
  Care Compare affiliation

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

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647993600000",
    "number": "1205891207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "252 MATLOCK RD STE 130",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760634295",
            "telephone_number": "682-242-8990",
            "fax_number": "682-242-8996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "252 MATLOCK RD STE 130",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760634295",
            "telephone_number": "682-242-8990",
            "fax_number": "682-242-8996"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2800 E Broad St Ste 512",
            "address_purpose": "LOCATION",
            "city": "Mansfield",
            "state": "TX",
            "postal_code": "760636417",
            "country_code": "US",
            "telephone_number": "817-473-6867",
            "fax_number": "817-453-0954",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "JOHN",
        "middle_name": "M",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-20",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "J0366",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "129827510",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "8X9688",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tavier Williams
• Telyn Williams
• Teresa Jean Williams, CPM, LM
• Tyah Chantyce Williams, MS, LPC ASSOCIATE
• Vonteshea L Williams, MS, LPC ASSOCIATE
• Willow & Stone Integrative Mental Health PLLC
• Willow Tree Dental, PLLC
• Andrea Leigh Wilson, N.P.
• Auralila Wilson, LPC-A
• Catherine Wardlow Wimbrey, LPC

• Internal Medicine Physician in Mansfield, TX
• Providers in Mansfield, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; 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.