Selwyn Willis, DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

License

1000 Issued in TX

Practice address

609 E Whaley St
Longview, TX 75601-6526

Phone

(903) 753-3316

Fax

(903) 753-4344

NPI assigned

Jun 22, 2005

Last updated

Dec 16, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

Other, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• I E Willis Jr DPM PC

  • Podiatrist
  • Longview, TX
  • NPI 1851579643
  NPD Authorized official

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

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323993600000",
    "number": "1356347637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2202",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756062202",
            "telephone_number": "903-753-3316",
            "fax_number": "903-753-3316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 E WHALEY ST",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756016526",
            "telephone_number": "903-753-3316",
            "fax_number": "903-753-4344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "SELWYN",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-22",
        "last_updated": "2011-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "TX",
            "license": "1000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "018656101",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eric D Willie
• Kimberly Parrott Willingham
• Kyle Alan Willingham, M.D.
• Deborah Willis, R.PH.
• Margaret Willis, RBT
• Sheila W Willis, LPC
• Summer Willis, FNP
• Willow Bend Center
• Allessia Wilson, MD
• Amy Ann Wilson, PT

• Podiatrist in Longview, TX
• Providers in Longview, TX by specialty
• Podiatrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2011; 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.