Jerrold C Willis, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

36057038 Issued in IL

Practice address

1 Good Samaritan Way
Radiology Dept
Mount Vernon, IL 62864-2402

Phone

(618) 242-4600

NPI assigned

May 23, 2006

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 3

Medicare fee-for-service enrollment

Enrolled in IL

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

Diagnostic RadiologyAlso: Interventional Radiology, Nuclear Medicine

Education

Southern Illinois University School of Medicine, 1977

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Crawford Hospital DistrictGroup PAC ID 7719898071, shared by 8 NPIs, 71 clinicians

Asbery and Associates OB GYN LLCGroup PAC ID 6507993136, 9 clinicians

Specialists in Medical Imaging SCGroup PAC ID 2163733544, 228 clinicians

County of ClayGroup PAC ID 0042101982, 77 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Deaconess Illinois Crossroads Hospital, Mount Vernon, IL, CCN 140294
• Wabash General Hospital 1 Hospital, Mount Carmel, IL, CCN 141327
• Heartland Regional Medical Center Hospital, Marion, IL, CCN 140184
• Fairfield Memorial Hospital 1 Hospital, Fairfield, IL, CCN 141311
• Red Bud Regional Hospital Hospital, Red Bud, IL, CCN 141348

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

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 and National Provider Directory roles.

• Asbery and Associates OB GYN LLC

  • Obstetrics & Gynecology Physician
  • Mount Vernon, IL
  • NPI 1033440722
  Medicare reassignment Care Compare group NPD
• County of Clay

  • Critical Access Hospital
  • Flora, IL
  • NPI 1184655136
  Medicare reassignment Care Compare group NPD
• Specialists in Medical Imaging, SC

  • Diagnostic Radiology Physician
  • Olympia Fields, IL
  • NPI 1841687951
  Medicare reassignment Care Compare group NPD
• Crawford Hospital District

  • Critical Access Hospital
  • Robinson, IL
  • NPI 1265493720
  Medicare reassignment NPD
• Crawford Hospital District

  • Internal Medicine Physician
  • Robinson, IL
  • NPI 1861423287
  Medicare reassignment NPD
• St. Mary'S Hospital, Centralia, Illinois

  • Emergency Medicine Physician
  • Centralia, IL
  • NPI 1770687196

  Diagnostic Radiology

  Medicare reassignment NPD
• County of Clay

  • Community/Retail Pharmacy
  • Flora, IL
  • NPI 1235990276
  NPD
• County of Clay

  • Rural Health Clinic/Center
  • Flora, IL
  • NPI 1811946411
  NPD
• Crawford Hospital District

  • Urology Physician
  • Newton, IL
  • NPI 1265309405
  NPD
• St. Mary'S Hospital, Centralia, Illinois

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Centralia, IL
  • NPI 1710105192
  NPD

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

• Deaconess Illinois Crossroads Inc

  • General Acute Care Hospital
  • Mount Vernon, IL
  • NPI 1124745807
  Care Compare affiliation
• Deaconess Illinois Red Bud Regional Hospital Inc

  • Critical Access Hospital
  • Red Bud, IL
  • NPI 1407573132
  Care Compare affiliation
• Deaconess Regional Healthcare Services Illinois Inc

  • General Acute Care Hospital
  • Marion, IL
  • NPI 1750007266
  Care Compare affiliation
• Fairfield Memorial Hospital Association

  • Critical Access Hospital
  • Fairfield, IL
  • NPI 1255422416
  Care Compare affiliation
• Wabash General Hospital District

  • Critical Access Hospital
  • Mount Carmel, IL
  • NPI 1194728808
  Care Compare affiliation
• Wabash General Hospital District

  • Ambulance
  • Mount Carmel, IL
  • NPI 1194814178

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615766400000",
    "number": "1467407072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2153 DEPT 20002",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352870001",
            "telephone_number": "877-465-0012",
            "fax_number": "303-438-1351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GOOD SAMARITAN WAY",
            "address_2": "RADIOLOGY DEPT",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642402",
            "telephone_number": "618-242-4600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "JERROLD",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2021-03-15",
        "certification_date": "2021-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "36057038",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD ST JOES/UTLAH",
            "identifier": "300119485",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD GOOD SAM & ST MARY'S",
            "identifier": "300117217",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036057038-3",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Justin R Williams
• Kate Williams
• Lydia Ann Williams, PH.D.
• Alan D. Willis, D.D.S.
• Amber Dawn Willis, APN-BC
• John Ryan Willis, MD
• Vicky Michelle Willis, HEARING INSTURMENT S
• Angela Renee Wilson, LPC
• Elesha Wilson, LPN
• Mary J Wilson, MS LCPC

• Diagnostic Radiology Physician in Mount Vernon, IL
• Providers in Mount Vernon, IL by specialty
• Diagnostic Radiology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2021; 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.