Active NPI
Edward R Willis Jr., MD
- Otolaryngology Physician
- Bay St Louis, MS
National Provider Identifier
1497794259
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 10751
- Practice address
- 100 Drinkwater Rd
Bay St Louis, MS 39520-1614 - Phone
- (228) 467-5121
- NPI assigned
- Jun 6, 2006
- Reactivated
- Oct 27, 2026
- Last updated
- Oct 27, 2026
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 41094 | TN | |
| Otolaryngology Physician | 207Y00000X | 10751 | MS | Primary |
Addresses
Primary practice location
100 Drinkwater Rd
Bay St Louis, MS 39520-1614
Mailing address
PO Box 2697
Bay St Louis, MS 39521-2697
Phone (228) 467-5121
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
Care Compare profile
Medicare Care Compare- Specialty
- Otolaryngology
- Education
- University of Mississippi School of Medicine, 1984
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
P O Box
Suite 2697
Bay St Louis, MS 39521-2697
PO Box
Suite 2697
Bay St Louis, MS 39521-2697
Hospital & facility affiliations
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 41094 | TN | MD | Otolaryngology Physician |
Interoperability endpoints
- ewillis@direct.mhg.com
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Ochsner Medical Center - Hancock
- General Acute Care Hospital
- Bay Saint Louis, MS
- NPI 1588629968
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1793059200000",
"number": "1497794259",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2697",
"city": "BAY ST LOUIS",
"state": "MS",
"postal_code": "395212697",
"telephone_number": "228-467-5121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 DRINKWATER RD",
"city": "BAY ST LOUIS",
"state": "MS",
"postal_code": "395201614",
"telephone_number": "228-467-5121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "EDWARD",
"middle_name": "R",
"name_suffix": "Jr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-06",
"last_updated": "2026-10-27",
"deactivation_date": "2026-03-24",
"reactivation_date": "2026-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "TN",
"license": "41094",
"primary": false
},
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "MS",
"license": "10751",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bay St Louis, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 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.