NPIMap

Individual provider Active NPI

John Ryan Willis, MD

  • Diagnostic Radiology Physician
  • Mount Vernon, IL
National Provider Identifier
1326095670
Registry record updated Mar 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
36108723 Issued in IL
Practice address
1 Good Samaritan Way
Mount Vernon, IL 62864-2402
Phone
(618) 242-4600
NPI assigned
May 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 36108723 IL Primary

Addresses

Primary practice location

1 Good Samaritan Way
Mount Vernon, IL 62864-2402

Mailing address

PO Box 2153 Dept 20002
Birmingham, AL 35287-0001
Phone (303) 465-0401

Other identifiers 3

IdentifierTypeStateIssuer
P00040956OtherILRAILROAD GOOD SAM & ST MARY'S
P00077831OtherILRAILROAD ST JOE & UTLAH
036108723-3MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, MO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040709001422 IL Practitioner - Diagnostic RadiologyPractitioner - Nuclear MedicinePractitioner - Interventional Radiology 2567440175 Reassigns benefits to 9 organizations
I20260428000964 MO Practitioner - Diagnostic Radiology 2567440175 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic RadiologyAlso: Interventional Radiology, Nuclear Medicine
Education
Southern Illinois University School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Imaging Associates of Indiana PCGroup PAC ID 1254503345, 293 clinicians
Blessing HospitalGroup PAC ID 3072422534, 414 clinicians
Crawford Hospital DistrictGroup PAC ID 7719898071, shared by 8 NPIs, 71 clinicians
Specialists in Medical Imaging SCGroup PAC ID 2163733544, 228 clinicians
Asbery and Associates OB GYN LLCGroup PAC ID 6507993136, 9 clinicians
County of ClayGroup PAC ID 0042101982, 77 clinicians

Practice addresses (Care Compare)

1 Ingalls Dr
Harvey, IL 60426-3558
Phone (219) 767-6320

100 Medical Dr
Hannibal, MO 63401-6877
Phone (217) 223-8400

1000 N Allen St
Robinson, IL 62454-1114
Phone (618) 546-5600

17186 N Tolle LN
Mount Vernon, IL 62864-8290
Phone (219) 767-6320

8 Cusumano Professional Plaza Dr
Mount Vernon, IL 62864-6736
Phone (618) 244-4800

911 Stacey Burk Dr
Flora, IL 62839-3241
Phone (618) 662-2131

927 Broadway St
Quincy, IL 62301-2719
Phone (217) 224-6423

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36108723ILMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Asbery and Associates OB GYN LLC CurrentSince Mar 1, 2023 Accepting new patients
Advanced Surgical Technology, LLC CurrentSince Jan 10, 2024 Accepting new patients
Advanced Surgical Technology, LLC CurrentSince Jan 10, 2024 Accepting new patients
Specialists in Medical Imaging, SC Diagnostic Radiology CurrentSince Oct 25, 2022 Accepting new patients
County of Clay CurrentSince Jul 1, 2025 Accepting new patients
Imaging Associates of Indiana, PC Diagnostic Radiology CurrentSince Dec 14, 2025 Accepting new patients
County of Clay Current Accepting new patients
St. Mary'S Hospital, Centralia, Illinois Diagnostic Radiology CurrentSince May 16, 2011 Accepting new patients
Crawford Hospital District CurrentSince Dec 23, 2023 Accepting new patients
Crawford Hospital District CurrentSince Dec 23, 2023 Accepting new patients
County of Clay CurrentSince Jul 1, 2025 Accepting new patients
St. Mary'S Hospital, Centralia, Illinois CurrentSince May 16, 2011 Accepting new patients
Crawford Hospital District Current Accepting new patients

Locations

42 Garden Ctr
Broomfield, CO 80020

400 N Pleasant Ave
Centralia, IL 62801
Phone (618) 436-5221

7420 Solutions Ctr
Chicago, IL 60677
Phone (314) 989-3155

911 Stacey Burk Dr
Flora, IL 62839
Phone (618) 662-2161

1 Ingalls Dr
Harvey, IL 60426
Phone (708) 333-2300

8 Cusumano Professional Plaza Dr
Mount Vernon, IL 62864
Phone (618) 242-7819

1 Good Samaritan Way
Mount Vernon, IL 62864
Phone (618) 242-4600

4225 Lincolnshire Dr
Ste B
Mount Vernon, IL 62864

8 Doctors Park Rd
Mount Vernon, IL 62864
Phone (618) 244-5500

600 S 13th St
Pekin, IL 61554
Phone (309) 347-1151

1000 N Allen St
Robinson, IL 62454
Phone (618) 544-3131

100 Medical Dr
Hannibal, MO 63401

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 11

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

NPI Registry JSON

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

{
    "created_epoch": "1148947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615766400000",
    "number": "1326095670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2153 DEPT 20002",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352870001",
            "telephone_number": "303-465-0401",
            "fax_number": "303-438-1351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GOOD SAMARITAN WAY",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642402",
            "telephone_number": "618-242-4600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "JOHN",
        "middle_name": "RYAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-30",
        "last_updated": "2021-03-15",
        "certification_date": "2021-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "36108723",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD GOOD SAM & ST MARY'S",
            "identifier": "P00040956",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD   ST JOE & UTLAH",
            "identifier": "P00077831",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036108723-3",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, IL

Sources for this page

Verify at the official NPI Registry.