Active NPI
Grace Roselle Willis, DO
- Neuromusculoskeletal Medicine & OMM Physician
- Bakersfield, CA
National Provider Identifier
1427155506
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neuromusculoskeletal Medicine & OMM Physician
- License
- 20A5477
- Practice address
- 3106 Old Farm Road
Bakersfield, CA 93312-3402 - Phone
- (661) 395-1835
- Fax
- (661) 589-8311
- NPI assigned
- Sep 20, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neuromusculoskeletal Medicine & OMM Physician | 204D00000X | 20A5477 | CA | Primary |
Addresses
Primary practice location
3106 Old Farm Road
Bakersfield, CA 93312-3402
Mailing address
3106 Old Farm Road
Bakersfield, CA 93312-3402
Phone (661) 395-1835
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jun 13, 2016 through Jun 13, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20A5477 | CA | MD | Neuromusculoskeletal Medicine & OMM Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1427155506",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3106 OLD FARM ROAD",
"city": "BAKERSFIELD",
"state": "CA",
"postal_code": "933123402",
"telephone_number": "661-395-1835",
"fax_number": "661-589-8311"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3106 OLD FARM ROAD",
"city": "BAKERSFIELD",
"state": "CA",
"postal_code": "933123402",
"telephone_number": "661-395-1835",
"fax_number": "661-589-8311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "GRACE",
"middle_name": "ROSELLE",
"name_prefix": "Ms.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "204D00000X",
"taxonomy_group": "",
"desc": "Neuromusculoskeletal Medicine & OMM",
"state": "CA",
"license": "20A5477",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bakersfield, CA
- Willie Young's Home for Young Men (Walt's Home for Young Men 2)
- Mary Roxanne Williford
- Willis Education (The Nest & Company)
- Willis Education (The Nest & Company)
- Christopher Rockshawn Willis, RAS
- Jacquelyn Rose Willis
- Jenica Marissa Willis, LM, CPM, LVN, IBCLC
- Judy Willis
- Krystal Dawn Willis, CMA
- Robert E Willis, DDS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.