Simon Matt Willis, M.D.

Primary specialty

Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X

License

84680 Issued in GA

Practice address

114 Canal St Ste 503
Pooler, GA 31322-4261

Phone

(912) 450-6300

Fax

(912) 450-6303

NPI assigned

Apr 20, 2014

Last updated

Apr 16, 2020By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CO, SC2 enrollments

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 2

Specialty

Physical Medicine and Rehabilitation

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Intermountain Medical Group Grand Junction, LLCGroup PAC ID 3779707856, 297 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Intermountain Health St. Mary's Regional Hospital Hospital, Grand Junction, CO, CCN 060023
• Community Hospital Hospital, Grand Junction, CO, CCN 060054
• St. Marys Hospital and Medical Center Inc Inpatient rehabilitation facility, Grand Junction, CO, CCN 06T023

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Intermountain Medical Group Grand Junction, LLC

  • Orthopaedic Surgery Physician
  • Grand Junction, CO
  • NPI 1356765556

  Physical Medicine & Rehabilitation

  Medicare reassignment Care Compare group NPD
• National Health Rehabilitation LLC

  • Physical Medicine & Rehabilitation Physician
  • Edgewater, NJ
  • NPI 1780080218

  SC

  Medicare reassignment NPD
• Intermountain Medical Group Grand Junction, LLC

  dba DME - Wellington Neurosurgery Clinic

  • Durable Medical Equipment & Medical Supplies
  • Grand Junction, CO
  • NPI 1609737618
  NPD
• Intermountain Medical Group Grand Junction, LLC

  dba Intermountain Health Heart & Vascular - Delta Cardiology Satellite

  • Cardiovascular Disease Physician
  • Delta, CO
  • NPI 1821695370
  NPD
• St Mary's Hospital and Medical Center, Inc

  • Hematology & Oncology Physician
  • Grand Junction, CO
  • NPI 1275714081

  Physical Medicine & Rehabilitation

  NPD (past)
• St Mary's Hospital and Medical Center, Inc

  dba St Mary's Anticoagulation Clinic

  • General Acute Care Hospital
  • Grand Junction, CO
  • NPI 1619742806
  NPD (past)

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

• Colorado West Healthcare System

  dba Community Hospital

  • General Acute Care Hospital
  • Grand Junction, CO
  • NPI 1497723407
  Care Compare affiliation
• St Mary's Hospital and Medical Center, Inc

  dba St Mary's CareFlight

  • Ambulance
  • Grand Junction, CO
  • NPI 1164060877

  Hospital

  Care Compare affiliation
• St Mary's Hospital and Medical Center, Inc

  dba St Mary's Anticoagulation Clinic

  • General Acute Care Hospital
  • Grand Junction, CO
  • NPI 1619742806
  Care Compare affiliation
• St Mary's Hospital and Medical Center, Inc

  dba St Mary's Hospital & Medical Center Life Center OT/PT/SP

  • General Acute Care Hospital
  • Grand Junction, CO
  • NPI 1821647801
  Care Compare affiliation
• St. Mary's Hospital and Medical Center, Inc.

  dba Intermountain Health St Mary's Regional Hospital

  • General Acute Care Hospital
  • Grand Junction, CO
  • NPI 1699716027
  Care Compare affiliation
• St. Marys Hospital and Medical Center Inc

  dba St. Mary's Medical Center

  • Rehabilitation Hospital Unit
  • Grand Junction, CO
  • NPI 1124274436

  Inpatient rehabilitation facility

  Care Compare affiliation

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

{
    "created_epoch": "1397952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586995200000",
    "number": "1356761191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 CANAL ST STE 503",
            "city": "POOLER",
            "state": "GA",
            "postal_code": "313224261",
            "telephone_number": "912-450-6300",
            "fax_number": "912-450-6303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 CANAL ST STE 503",
            "city": "POOLER",
            "state": "GA",
            "postal_code": "313224261",
            "telephone_number": "912-450-6300",
            "fax_number": "912-450-6303"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "25 Sherington Dr Ste D",
            "address_purpose": "LOCATION",
            "city": "Bluffton",
            "state": "SC",
            "postal_code": "299106031",
            "country_code": "US",
            "telephone_number": "843-310-1055",
            "fax_number": "843-310-1056",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "514 S Main St Ste C",
            "address_purpose": "LOCATION",
            "city": "Hinesville",
            "state": "GA",
            "postal_code": "313134356",
            "country_code": "US",
            "telephone_number": "912-450-6300",
            "fax_number": "912-450-6303",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "SIMON",
        "middle_name": "MATT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-20",
        "last_updated": "2020-04-16",
        "certification_date": "2020-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "SC",
            "license": "83377",
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "GA",
            "license": "84680",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyarrah Williams
• Lakeisha Williams
• Zhanye Williams
• Parishee Williamson
• Tacidy Willie
• Caitlin Jane Wilmes
• Trevayne Wilson-Martinez
• Dyshawna Wilson
• Michelle Lermond Wilson, DO
• Randi Wilson, MS, CCC- SLP

• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Pooler, GA
• Providers in Pooler, GA by specialty
• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2020; 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.