Jennifer Louise Willis, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

81372 Issued in AZ

Practice address

1300 N 12TH St
Suite 605
Phoenix, AZ 85006-2848

Phone

(602) 239-4567

NPI assigned

Jul 10, 2007

Last updated

Nov 16, 2007By 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

Medicare fee-for-service enrollment

Enrolled in AZ

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

Family Practice

Education

University of Arizona College of Medicine, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Banner Primary Care Physicians Arizona LLCGroup PAC ID 6406020155, 236 clinicians

Midwestern UniversityGroup PAC ID 6305734773, 116 clinicians

Healthyu Family Medicine LLCGroup PAC ID 6204224918, 43 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/24378/brand/3/csg/1/fhir/r4
• Direct secure messaging: jennifer.willis.1@24378.direct.athenahealth.com
• Direct secure messaging: jwillis19835@direct.midwestern.edu

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.

• Banner Primary Care Physicians Arizona LLC

  • Primary Care Clinic/Center
  • Phoenix, AZ
  • NPI 1659640902
  Medicare reassignment Care Compare group NPD
• Healthyu Family Medicine, LLC

  • Multi-Specialty Clinic/Center
  • Mesa, AZ
  • NPI 1669149787

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Midwestern University

  dba Midwestern University Multispecialty Clinic

  • Multi-Specialty Clinic/Center
  • Glendale, AZ
  • NPI 1932206414
  Medicare reassignment Care Compare group NPD
• Alliance Urgent Care PLLC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Tolleson, AZ
  • NPI 1891888517
  Medicare reassignment NPD
• VHS Outpatient Clinics, Inc.

  dba Abrazo Medical Group

  • Multi-Specialty Clinic/Center
  • Goodyear, AZ
  • NPI 1912979964

  Family Medicine

  Medicare reassignment NPD
• Banner Primary Care Physicians Arizona LLC

  • Clinical Medical Laboratory
  • Peoria, AZ
  • NPI 1649544362
  NPD
• Banner Primary Care Physicians Arizona LLC

  • Primary Care Clinic/Center
  • Phoenix, AZ
  • NPI 1790306066
  NPD
• Midwestern University

  dba Midwestern University Eye Institute

  • Optometrist
  • Glendale, AZ
  • NPI 1891017745
  NPD
• VHS Outpatient Clinics, Inc.

  dba Arizona Sports Medicine Center (ASMC)

  • Durable Medical Equipment & Medical Supplies
  • Scottsdale, AZ
  • NPI 1891302790
  NPD
• Midwestern University

  dba Midwestern University Eye Institute-Downers Grove

  • Optometrist
  • Downers Grove, IL
  • NPI 1295126324
  NPD
• Arizona Heart Specialists PLLC

  • Cardiovascular Disease Physician
  • Lakeside, AZ
  • NPI 1750513438
  NPD (past)
• Luke W Garcia DO PLLC

  dba Precision Pain Management

  • Physical Medicine & Rehabilitation Physician
  • Mesa, AZ
  • NPI 1659764173
  NPD (past)

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

{
    "created_epoch": "1184025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195171200000",
    "number": "1275731424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 N 12TH ST",
            "address_2": "SUITE 605",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062848",
            "telephone_number": "602-239-2668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 N 12TH ST",
            "address_2": "SUITE 605",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850062848",
            "telephone_number": "602-239-4567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "JENNIFER",
        "middle_name": "LOUISE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-10",
        "last_updated": "2007-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "81372",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Ross Willis, MD
• Delaney Willis, PSYD
• Deshea Willis
• Elizabeth Willis, COTA/L
• Erin Nicole Willis, M.S. CFY--SLP
• Joshua Willis, MD
• Joyce Margaret Willis, LPC
• Latanya Maria Willis, FNP
• Lateisha Lynn Vantrice Willis, CNA
• Maurice Nicholas Willis

• Family Medicine Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2007; 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.