NPIMap

Individual provider Active NPI

Donovan Scott Willis, CRNA

  • Certified Registered Nurse Anesthetist
  • Joplin, MO
National Provider Identifier
1558460295
Registry record updated Jan 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
2015043775 Issued in MO
Practice address
100 Mercy Way
Joplin, MO 64804-4524
Phone
(417) 781-2727
NPI assigned
Sep 21, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 22, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 2015043775 MO Primary
Certified Registered Nurse Anesthetist 367500000X C01497 AR

Addresses

Primary practice location

100 Mercy Way
Joplin, MO 64804-4524

Mailing address

PO Box 11405
Fort Smith, AR 72917-1405
Phone (479) 785-2555

Other practice location 1

3002 Rogers Ave
Fort Smith, AR 72901-4232
Phone (479) 785-2555

Other identifiers 2

IdentifierTypeStateIssuer
200053830AMedicaidOK
156956001MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR, OK, MO3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20050208000777 AR Practitioner - Certified Registered Nurse Anesthetist (Crna) 0941259998 Reassigns benefits to 3 organizations
I20091023000549 OK Practitioner - Certified Registered Nurse Anesthetist (Crna) 0941259998 Reassigns benefits to 1 organization
I20160413002491 MO Practitioner - Certified Registered Nurse Anesthetist (Crna) 0941259998 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northeastern Health SystemGroup PAC ID 1456255025, 105 clinicians
Anesthesia Associates of Joplin LLCGroup PAC ID 6305156290, 10 clinicians
Pinnacle Anesthesia Group PLLCGroup PAC ID 9537514385, 14 clinicians
Renew Medical Group of MissouriGroup PAC ID 3476043233, 23 clinicians

Practice addresses (Care Compare)

1400 E Downing St
Tahlequah, OK 74464-3324
Phone (918) 456-0641

1531 E 32ND St
Suite 6
Joplin, MO 64804-2970
Phone (417) 627-9699

1905 E Mission Blvd
Suite 5
Fayetteville, AR 72703-3129
Phone (479) 439-4959

3050 E River Bluff Blvd
Ozark, MO 65721-8807
Phone (417) 885-3000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.91 of 100Reported as apm
Quality
76.55
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
C01497ARMDCertified Registered Nurse Anesthetist
2015043775MOMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Northeastern Health System CurrentSince Aug 15, 2015 Accepting new patients
Anesthesia Associates of Grand Lake CurrentSince Jul 10, 2015 Accepting new patients
Renew Medical Group of Missouri Nurse Anesthetist, Certified Registered CurrentSince Sep 29, 2025 Accepting new patients
Northstar Anesthesia of Missouri, LLC Nurse Anesthetist, Certified Registered CurrentSince Jan 1, 2025 Accepting new patients
Pinnacle Anesthesia Group, PLLC CurrentSince Oct 10, 2025 Accepting new patients
Anesthesia Associates of Joplin LLC Nurse Anesthetist, Certified Registered CurrentSince Mar 9, 2016 Accepting new patients
Northeastern Health System Current Accepting new patients
Northeastern Health System CurrentSince Aug 15, 2015 Accepting new patients
River Valley Anesthesia Associates, P. a. Past Accepting new patients
Clinical Partners PA Nurse Anesthetist, Certified Registered Past Accepting new patients
Van Buren Hma Inc Past Accepting new patients

Locations

3721 S Champions Dr
Ste 100
Rogers, AR 72758
Phone (479) 336-5150

1531 E 32nd St
Ste 6
Joplin, MO 64804
Phone (417) 627-9699

100 Mercy Way
Joplin, MO 64804
Phone (417) 556-2300

3050 E River Bluff Blvd
Ozark, MO 65721
Phone (417) 820-5610

213 E Redwood Ave
Sallisaw, OK 74955
Phone (918) 774-1100

1400 E Downing St
Tahlequah, OK 74464
Phone (918) 456-0641

1400 E Downing St
Ste 100
Tahlequah, OK 74464

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/932b43fb-c766-413c-a343-640549d20cb3/

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737504000000",
    "number": "1558460295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11405",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729171405",
            "telephone_number": "479-785-2555",
            "fax_number": "479-785-3555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MERCY WAY",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648044524",
            "telephone_number": "417-781-2727"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3002 Rogers Ave",
            "address_purpose": "LOCATION",
            "city": "Fort Smith",
            "state": "AR",
            "postal_code": "729014232",
            "country_code": "US",
            "telephone_number": "479-785-2555",
            "fax_number": "479-785-3555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "DONOVAN",
        "middle_name": "SCOTT",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-21",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MO",
            "license": "2015043775",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AR",
            "license": "C01497",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200053830A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "156956001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Joplin, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.