Kimberly Rachelle Willis, MD

Primary specialty

Hospitalist PhysicianTaxonomy code 208M00000X

License

E-5445 Issued in AR

Practice address

1600 W 40TH Ave
Pine Bluff, AR 71603-6301

Phone

(870) 541-8767

Fax

(870) 541-8761

NPI assigned

Jul 10, 2007

Last updated

Jul 10, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

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

University Central del Caribe Escuela de Medicina, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jefferson Hospital Association, IncGroup PAC ID 8123927431, 80 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Affinity Hospice Hospice, White Hall, AR, CCN 041560
• Jefferson Regional Medical Center Hospital, Pine Bluff, AR, CCN 040071
• Unity Health - Jacksonville Hospital, Jacksonville, AR, CCN 040164

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kimberly.willis@4247.securemail.prognocis.com

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Affinity Hospice Arkansas, LLC

  dba Affinity Hospice

  • Community Based Hospice Care Agency
  • White Hall, AR
  • NPI 1932874757

  W-2 Managing Employee

  CMS ownership

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.

• Jefferson Hospital Association, Inc

  • Pulmonary Disease Physician
  • Pine Bluff, AR
  • NPI 1932157674
  Medicare reassignment Care Compare group NPD
• Southeast Arkansas Hospitalists, LLP

  • Hospitalist Physician
  • Pine Bluff, AR
  • NPI 1912374018
  Medicare reassignment NPD
• Jefferson Hospital Association, Inc

  • Rural Health Clinic/Center
  • Crossett, AR
  • NPI 1225799646

  Family Medicine

  NPD
• Jefferson Hospital Association, Inc

  • Family Medicine Physician
  • Star City, AR
  • NPI 1568123982
  NPD
• White River Health System, Inc

  dba White River Med Physicians

  • Anesthesiology Physician
  • Batesville, AR
  • NPI 1760410229

  Family Medicine

  NPD (past)
• White River Health System, Inc.

  dba Stone County Medical Center ER Clinic

  • Emergency Medical Services (Emergency Medicine) Physician
  • Mountain View, AR
  • NPI 1427149814
  NPD (past)

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

• Affinity Hospice Arkansas, LLC

  dba Affinity Hospice

  • Community Based Hospice Care Agency
  • White Hall, AR
  • NPI 1932874757
  Care Compare affiliation
• Jefferson Hospital Association Inc

  dba Jefferson Regional Medical Center

  • General Acute Care Hospital
  • Pine Bluff, AR
  • NPI 1710931985
  Care Compare affiliation
• Unity Health - Jacksonville

  • Psychiatric Hospital
  • Jacksonville, AR
  • NPI 1245954460
  Care Compare affiliation

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

{
    "created_epoch": "1184025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720569600000",
    "number": "1487852562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "152 AVIARY CT",
            "city": "CLAYTON",
            "state": "NC",
            "postal_code": "275204054",
            "telephone_number": "501-733-8722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 W 40TH AVE",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716036301",
            "telephone_number": "870-541-8767",
            "fax_number": "870-541-8761"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2609 Medical Office Pl",
            "address_purpose": "LOCATION",
            "city": "Goldsboro",
            "state": "NC",
            "postal_code": "275349428",
            "country_code": "US",
            "telephone_number": "919-731-1779 x104",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "KIMBERLY",
        "middle_name": "RACHELLE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-07-10",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E-5445",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2009-01271",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NC",
            "license": "2009-01271",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "AR",
            "license": "E-5445",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margarette Anne Williams, ED.D, CCC
• Marina P Williams, MA, MHPP
• Michelle Sheriece Williams
• Nancy K Williams, M.D.
• Yolanda Williams
• Nicholas Willis, MD
• Brandy Wilson Reed, OTR
• Christy Michelle Wilson-Eggburn, FNP-BC
• Candace Wilson
• Eryn Nicole Wilson, MS, CF-SLP

• Hospitalist Physician in Pine Bluff, AR
• Providers in Pine Bluff, AR by specialty
• Hospitalist Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; 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.