Michelle Dianne Willis, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036130518 Issued in IL

Practice address

12151 Regency Pkwy Ste 155
Huntley, IL 60142-7644

Phone

(847) 506-4400

NPI assigned

Jun 1, 2009

Last updated

Oct 16, 2020By the provider in NPPES

Sex

Female

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 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Interoperability endpoints

• Direct secure messaging: mwillis109553@ce-direct.presencehealth.org

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

{
    "created_epoch": "1243814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602806400000",
    "number": "1255567574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12151 REGENCY PKWY STE 155",
            "city": "HUNTLEY",
            "state": "IL",
            "postal_code": "601427644",
            "telephone_number": "847-506-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12151 REGENCY PKWY STE 155",
            "city": "HUNTLEY",
            "state": "IL",
            "postal_code": "601427644",
            "telephone_number": "847-506-4400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2201 Randall Rd",
            "address_purpose": "LOCATION",
            "city": "Carpentersville",
            "state": "IL",
            "postal_code": "601103355",
            "country_code": "US",
            "telephone_number": "847-551-1859",
            "fax_number": "847-783-0628",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1975 Lin Lor Ln Ste 205",
            "address_purpose": "LOCATION",
            "city": "Elgin",
            "state": "IL",
            "postal_code": "601234946",
            "country_code": "US",
            "telephone_number": "847-742-4111",
            "fax_number": "847-742-4545",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2425 Fargo Blvd",
            "address_purpose": "LOCATION",
            "city": "Geneva",
            "state": "IL",
            "postal_code": "601343591",
            "country_code": "US",
            "telephone_number": "630-232-2200",
            "fax_number": "630-232-1940",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "MICHELLE",
        "middle_name": "DIANNE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-01",
        "last_updated": "2020-10-16",
        "certification_date": "2020-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036130518",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036130518",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mwillis109553@ce-direct.presencehealth.org",
            "affiliation": "N",
            "address_1": "12151 Regency Pkwy Ste 155",
            "city": "Huntley",
            "state": "IL",
            "country_code": "US",
            "postal_code": "601427644",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Family Medicine Physician in Huntley, IL
• Providers in Huntley, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.