Active NPI
Chanel Lawanda Willis, MD
- Family Medicine Physician
- Fredericksburg, VA
National Provider Identifier
1487359188
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 0101284697
- Practice address
- 130 Executive Center Pkwy
Fredericksburg, VA 22401-3100 - Phone
- (540) 741-3324
- NPI assigned
- Apr 3, 2023
- Last updated
- Aug 21, 2026
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Family Medicine Physician | 207Q00000X | 0101284697 | VA | Primary |
Addresses
Primary practice location
130 Executive Center Pkwy
Fredericksburg, VA 22401-3100
Mailing address
1340 Central Park Blvd Ste 100
Fredericksburg, VA 22401-4940
Other practice location 1
10510 Jefferson Ave Ste B
Newport News, VA 23601-3102
Phone (757) 594-3800
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Other, 2022
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
4560 S Blvd
Suite 200
Virginia Beach, VA 23452
PO Box
Suite 5508
Virginia Beach, VA 23471
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Interoperability endpoints
- cwillis216972@direct.rivhs.com
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1680480000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787270400000",
"number": "1487359188",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1340 CENTRAL PARK BLVD STE 100",
"city": "FREDERICKSBURG",
"state": "VA",
"postal_code": "224014940"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 EXECUTIVE CENTER PKWY",
"city": "FREDERICKSBURG",
"state": "VA",
"postal_code": "224013100",
"telephone_number": "540-741-3324"
}
],
"practiceLocations": [
{
"address_1": "10510 Jefferson Ave Ste B",
"address_purpose": "LOCATION",
"city": "Newport News",
"state": "VA",
"postal_code": "236013102",
"country_code": "US",
"telephone_number": "757-594-3800",
"fax_number": "757-591-9021",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILLIS",
"first_name": "CHANEL",
"middle_name": "LAWANDA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-04-03",
"last_updated": "2026-08-21",
"certification_date": "2026-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "VA",
"license": "0101284697",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Fredericksburg, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2026; 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.