Jeremy David Willes, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA638 Issued in ID

Practice address

260 Falls Ave
Suite C
Twin Falls, ID 83301-3370

Phone

(208) 736-7422

Fax

(208) 736-8905

NPI assigned

Feb 7, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Physicians Immediate Care of Twin Falls PAGroup PAC ID 0143460717, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jeremy.willes.1@29843.direct.athenahealth.com

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.

• Physicians Immediate Care of Twin Falls PA

  • Urgent Care Clinic/Center
  • Twin Falls, ID
  • NPI 1114141090
  Medicare reassignment Care Compare group Authorized official
• East Suburban Rehabilitation Assoc., Inc

  • Physical Medicine & Rehabilitation Physician
  • Monroeville, PA
  • NPI 1699702506
  NPD (past)

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

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1367971200000",
    "number": "1356314843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 FALLS AVE",
            "address_2": "SUITE C",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833013370",
            "telephone_number": "208-736-7422",
            "fax_number": "208-736-8905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 FALLS AVE",
            "address_2": "SUITE C",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833013370",
            "telephone_number": "208-736-7422",
            "fax_number": "208-736-8905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLES",
        "first_name": "JEREMY",
        "middle_name": "DAVID",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-07",
        "last_updated": "2013-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA638",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NV",
            "license": "PA882",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010161378",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807683300",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807683301",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "PAE68",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010161377",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100504125",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "PAE69",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deena Michelle Wiley-Vegwert, MS
• Wilhelm Chiropractic LLC
• Cody Wilhelm, DC
• Jacob Jeremiah Wilkins
• Robert Shawn Wilkinson, LCPC
• William C Fitzhugh MD PA
• William F May MD PA
• Williams and Williams LLC
• Williams Chiropractic Pain Relief Clinic PC
• Andrea Williams

• Physician Assistant in Twin Falls, ID
• Providers in Twin Falls, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2013; 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.