NPIMap

Individual provider Active NPI

Gary Paul Willers II, DO

  • Family Medicine Physician
  • Cuero, TX
National Provider Identifier
1255625422
Registry record updated Oct 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
P5906 Issued in TX
Practice address
2500 N Esplanade St Ste 102
Cuero, TX 77954-4727
Phone
(361) 275-3466
Fax
(361) 275-3460
NPI assigned
Jun 6, 2011
Last updated
Oct 2, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 2, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2778 TN
Family Medicine Physician 207Q00000X P5906 TX Primary

Addresses

Primary practice location

2500 N Esplanade St Ste 102
Cuero, TX 77954-4727

Mailing address

2500 N Esplanade
Suite 102
Cuero, TX 77954
Phone (361) 275-3466

Other practice location 1

508 N Riedel St
Yorktown, TX 78164-1810
Phone (361) 564-9230

Other identifiers 3

IdentifierTypeStateIssuer
336088504MedicaidTX
336088503MedicaidTX
482545YK7YOtherTXMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160324000603 TX Practitioner - Family PracticePractitioner - Obstetrics/Gynecology 6204053218 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Obstetrics/Gynecology
Education
University of North Texas HSC, College of Osteopathic Med, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dewitt Medical DistrictGroup PAC ID 3072421395, 32 clinicians

Practice addresses (Care Compare)

1109 E Broadway St
Parkside Family Clinic
Cuero, TX 77954-2108
Phone 36127561912474

113 W Main St
Kenedy Family Practice
Kenedy, TX 78119-2717
Phone (830) 583-0612

2500 N Esplanade St
Cuero, TX 77954-4723

2500 N Esplanade St
Cuero, TX 77954-4727
Phone (361) 275-3466

508 N Riedel St
Yorktown Medical Clinic
Yorktown, TX 78164-1810
Phone (361) 564-9230

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
P5906TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dewitt Medical District CurrentSince Feb 14, 2016 Accepting new patients
Dewitt Medical District Current Accepting new patients
Infinite Medical PC Family Medicine CurrentSince Dec 22, 2022 Accepting new patients
The Camellia Foundation Family Medicine CurrentSince Jan 1, 2015 Accepting new patients
Dewitt Medical District Family Medicine CurrentSince Feb 14, 2016 Accepting new patients
Medicos General PLLC Family Medicine CurrentSince Jan 12, 2015 Accepting new patients
Hamilton County Hospital District Past Accepting new patients
Citizens Medical Center County of Victoria Past Accepting new patients
Dewitt Medical District Past Accepting new patients
Dewitt Medical District Past Accepting new patients
Citizens Medical Center County of Victoria Past Accepting new patients
Oakbend Medical Center Past Accepting new patients

Locations

250 Skillman St
Ste 202
Brooklyn, NY 11205

3030 Covington Pike
#200
Memphis, TN 38128
Phone (901) 432-5727

3030 Covington Pike
Ste 100
Memphis, TN 38128
Phone (615) 277-0760

3040 Covington Pike
#100
Memphis, TN 38128
Phone (901) 729-7801

1109 E Broadway St
Cuero, TX 77954
Phone (361) 275-2800

2500 N Esplanade St
Ste 102
Cuero, TX 77954
Phone (361) 275-3466

2550 N Esplanade St
Cuero, TX 77954
Phone (361) 275-0532

139 W Franklin St
Goliad, TX 77963
Phone (361) 645-8235

113 W Main St
Kenedy, TX 78119
Phone (830) 583-0612

411 Airport Rd
Sulphur Springs, TX 75482
Phone (903) 885-7668

8001 Western Hills Blvd
Wht Settlemt, TX 76108
Phone (817) 246-4953

508 N Riedel St
Yorktown, TX 78164
Phone (361) 564-3383

Interoperability endpoints

  • Direct secure messaging: paulwillers@dmdclinic.allscriptsdirect.net

Ownership & related parties

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Cuero Nursing and Rehabilitation CenterCuero, TX, CCN 675110 Skilled nursing facility Adp of the SNF Jan 1, 2025
Whispering Oaks Rehab & NursingCuero, TX, CCN 675134 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 May 15, 2024
May 15, 2024

Owned or controlled facilities with NPI records 2

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

Organizations & group practices 12

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.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1307318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727827200000",
    "number": "1255625422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 N ESPLANADE",
            "address_2": "SUITE 102",
            "city": "CUERO",
            "state": "TX",
            "postal_code": "77954",
            "telephone_number": "361-275-3466",
            "fax_number": "361-275-3460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 N ESPLANADE ST STE 102",
            "city": "CUERO",
            "state": "TX",
            "postal_code": "779544727",
            "telephone_number": "361-275-3466",
            "fax_number": "361-275-3460"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "508 N Riedel St",
            "address_purpose": "LOCATION",
            "city": "Yorktown",
            "state": "TX",
            "postal_code": "781641810",
            "country_code": "US",
            "telephone_number": "361-564-9230",
            "fax_number": "361-564-9246",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLERS",
        "first_name": "GARY",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-06-06",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "2778",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "P5906",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "336088504",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "336088503",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "482545YK7Y",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cuero, TX

Sources for this page

Verify at the official NPI Registry.