Nicholas Andrew Willis

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

201900742RN Issued in OR

Practice address

3455 SW US Veterans Hospital Rd
Portland, OR 97239-3076

Phone

(360) 431-4408

NPI assigned

Jul 23, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR, WA2 enrollments

Enrollment records 2

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

PeacehealthGroup PAC ID 5890689293, 188 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Peacehealth St John Medical Center Hospital, Longview, WA, CCN 500041

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nwillis390062@direct.peacehealth.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Peacehealth

  • Multi-Specialty Clinic/Center
  • Longview, WA
  • NPI 1720056187
  Medicare reassignment Care Compare group NPD
• Anesthetic Solutions, Inc

  • Certified Registered Nurse Anesthetist
  • Medford, OR
  • NPI 1477022259

  WA

  Medicare reassignment NPD
• Paceline Anesthesia, PLLC

  • Certified Registered Nurse Anesthetist
  • Bellevue, WA
  • NPI 1417273780
  Medicare reassignment NPD
• Peacehealth

  • General Acute Care Hospital
  • Vancouver, WA
  • NPI 1134178999
  Medicare reassignment NPD
• Anesthesia Associates Northwest LLC

  • Anesthesiology Physician
  • Milwaukie, OR
  • NPI 1548281751
  Medicare reassignment

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

• Peacehealth

  • General Acute Care Hospital
  • Longview, WA
  • NPI 1073510277
  Care Compare affiliation

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

{
    "created_epoch": "1563840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563840000000",
    "number": "1609429125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3455 SW US VETERANS HOSPITAL RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393076",
            "telephone_number": "360-431-4408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3455 SW US VETERANS HOSPITAL RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393076",
            "telephone_number": "360-431-4408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "NICHOLAS",
        "middle_name": "ANDREW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-23",
        "last_updated": "2019-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OR",
            "license": "201900742RN",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jared Helaman Willis, D.D.S.
• Jennifer Willis, QMHA
• Jessica Willis, MSW
• Kernan Willis
• Margaret Willis, LCSW
• Nicole Christiane Willis
• Nural Willis III
• Rasa Willis, LMT
• Shelby Willis
• Vyshika M Willis, LMFT

• Registered Nurse in Portland, OR
• Providers in Portland, OR by specialty
• Registered Nurse in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2019; 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.