Gary Marvin Willard, M.D.

Primary specialty

Undersea and Hyperbaric Medicine (Emergency Medicine) PhysicianTaxonomy code 207PE0005X

License

254000 Issued in NY

Practice address

2588F El Camino Real Ste 127
Carlsbad, CA 92008-1201

Phone

(619) 564-4644

Fax

(619) 810-2430

NPI assigned

Mar 22, 2007

Last updated

Oct 18, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

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

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Healogics Specialty Physicians of Texas, PLLC

  • Surgery Physician
  • Allen, TX
  • NPI 1285051094
  Medicare reassignment NPD
• Tri-City Hospital

  dba Tri-City Medical Center

  • Psychiatric Hospital Unit
  • Oceanside, CA
  • NPI 1770558710
  NPD (past)

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571356800000",
    "number": "1588780373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2588F EL CAMINO REAL STE 127",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920081201",
            "telephone_number": "619-564-4644",
            "fax_number": "619-810-2430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2588F EL CAMINO REAL STE 127",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920081201",
            "telephone_number": "619-564-4644",
            "fax_number": "619-810-2430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLARD",
        "first_name": "GARY",
        "middle_name": "MARVIN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-22",
        "last_updated": "2019-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A34995",
            "primary": false
        },
        {
            "code": "207PE0005X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Undersea and Hyperbaric Medicine",
            "state": "NY",
            "license": "254000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03132152",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "FE799Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Molly Mae Wildfeuer, M.A.
• Julianne Wiley
• Kendra Wilhelm, MA, LMFT
• Amy Michelle Wilke, RN
• Erin Will
• Michael Glen Willes, DDS
• Melissa Marie Willey, O.D.
• Amy Elizabeth Williams, OTR/L
• Andrea Williams
• Bernice Williams

• Undersea and Hyperbaric Medicine (Emergency Medicine) Physician in Carlsbad, CA
• Providers in Carlsbad, CA by specialty
• Undersea and Hyperbaric Medicine (Emergency Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.