Active NPI
Jared Willis
- Emergency Medicine Physician
- Fort Worth, TX
National Provider Identifier
1316441504
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 2021-01659
- Practice address
- 1500 S Main St
Fort Worth, TX 76104-4917 - Phone
- (817) 702-1173
- NPI assigned
- Mar 21, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 2021-01659 | NC | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
1500 S Main St
Fort Worth, TX 76104-4917
Mailing address
1500 S Main St
Fort Worth, TX 76104-4917
Phone (817) 702-1173
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Emergency Medicine
- Education
- University of Alabama School of Medicine, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
509 Biltmore Ave
Asheville, NC 28801-4601
Phone (828) 213-1111
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2021-01659 | NC | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cfvhs Ed Physicians | Emergency Medicine | Current | Accepting new patients |
| Cfvhs Ed Physicians | Single Specialty | Current | Accepting new patients |
| Emergency Coverage, LLC | Single Specialty | Current | Accepting new patients |
| Emergency Coverage Services, PC | Single Specialty | Past | Accepting new patients |
Locations
509 Biltmore Ave
Asheville, NC 28801
Phone (828) 213-2325
1638 Owen Dr
Fayetteville, NC 28304
Phone (910) 609-5610
615 Ridge Rd
Roxboro, NC 27573
Phone (336) 503-5699
Organizations & group practices 4
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.
-
- Emergency Medicine Physician
- Raeford, NC
- NPI 1790183184
Hospital & facility affiliations 8
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Marion, NC
- NPI 1225513948
-
- Rural Health Clinic/Center
- Forest City, NC
- NPI 1962978122
Hospital
-
- General Acute Care Hospital
- Asheville, NC
- NPI 1962987677
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1521590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629331200000",
"number": "1316441504",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1500 S MAIN ST",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761044917",
"telephone_number": "817-702-1173"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 S MAIN ST",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761044917",
"telephone_number": "817-702-1173"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "JARED",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-03-21",
"last_updated": "2021-08-19",
"certification_date": "2021-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Emergency Medicine",
"state": "NC",
"license": "2021-01659",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2021; 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.