Samuel Vaughan Hanson Willis, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

49888 Issued in MN

Practice address

2155 Ford Pkwy
Saint Paul, MN 55116-1862

Phone

(651) 696-5000

Fax

(651) 696-5001

NPI assigned

Aug 10, 2007

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 names 1

• Samuel Vaughan Willis Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: samuel.willis@217526021193732.direct.elationemr.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.

• Gillette Children'S Specialty Healthcare

  • Multi-Specialty Clinic/Center
  • Minnetonka, MN
  • NPI 1598824880
  NPD (past)
• National Dizzy & Balance Center,LTD.

  • Physical Medicine & Rehabilitation Physician
  • Bloomington, MN
  • NPI 1023021938
  NPD (past)

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

{
    "created_epoch": "1186704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615420800000",
    "number": "1467644757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2155 FORD PKWY",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551161862",
            "telephone_number": "651-696-5000",
            "fax_number": "651-696-5001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2155 FORD PKWY",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551161862",
            "telephone_number": "651-696-5000",
            "fax_number": "651-696-5001"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3270 W Lake St",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554164512",
            "country_code": "US",
            "telephone_number": "612-775-1800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HANSON WILLIS",
        "first_name": "SAMUEL",
        "middle_name": "VAUGHAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-10",
        "last_updated": "2021-03-11",
        "certification_date": "2021-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "49888",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "shansonwillis178199@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "3270 W Lake St",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554164512",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SAMUEL",
            "last_name": "WILLIS",
            "middle_name": "VAUGHAN",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jordan Hansen, LADC
• Mark P Hansen, PH.D.
• Payton Ann Hansen
• Rachel Ruth Hansen, MD
• Shelly A Hansen, CNNP
• Amy Hanson
• Barbara Ann Hanson, PHD LP
• Cheryl Lynn Hanson, LICENSEDPSYCHOLOGIST
• Coleton Joshua Dotson Hanson, RDN
• David S Hanson, MD

• Family Medicine Physician in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.