Brandy C. Willis, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME103588 Issued in FL

Practice address

2646 Centennial PL Ste a
Tallahassee, FL 32308-0573

Phone

(850) 702-0300

Fax

(850) 325-6015

NPI assigned

Jun 20, 2007

Sex

Female

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 FL

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 1

Specialty

Family Practice

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Abundant Life Institute, LLCGroup PAC ID 0345625273, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: brandy.willis.1@26161.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.

• Abundant Life Institute, LLC

  • Family Medicine Physician
  • Tallahassee, FL
  • NPI 1407505431
  Medicare reassignment Care Compare group NPD Authorized official
• Hospital Authority of the City of Bainbridge and Decatur County

  • Multi-Specialty Clinic/Center
  • Bainbridge, GA
  • NPI 1053388256
  NPD (past)

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

{
    "created_epoch": "1182297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665532800000",
    "number": "1457556268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12427",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323172427",
            "telephone_number": "850-297-0114",
            "fax_number": "850-297-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2646 CENTENNIAL PL STE A",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323080573",
            "telephone_number": "850-702-0300",
            "fax_number": "850-325-6015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "BRANDY",
        "middle_name": "C.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-20",
        "last_updated": "2022-10-12",
        "certification_date": "2022-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME103588",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002105700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Travis James Williams
• Verna M Williams
• Victoria D Williams, RBT
• Willie Lewis Williams, MSW
• Annie Catherine Willis, COTA/L
• Jason Paul Willis
• Kellie Love Willis, COTA/L
• Kendall Willis, FNP
• Mary Caitlin Willis, RN
• Ronald Gordan Willis Jr., DMD

• Family Medicine Physician in Tallahassee, FL
• Providers in Tallahassee, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2022; 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.