Jared Helaman Willis, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D9616 Issued in OR

Practice address

2038 Lloyd Ctr
Portland, OR 97232-1309

Phone

(503) 288-5361

NPI assigned

Jul 26, 2011

Last updated

Jul 26, 2011By the provider in NPPES

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1311638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311638400000",
    "number": "1659659589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10414 SE PINE ST",
            "address_2": "S107",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972164608",
            "telephone_number": "347-308-3811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2038 LLOYD CTR",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321309",
            "telephone_number": "503-288-5361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "JARED",
        "middle_name": "HELAMAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-26",
        "last_updated": "2011-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D9616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anne M Willis, PSYD
• Dale Michael Willis, M.D.
• David W Willis, MD
• Erik Willis
• Gloria Willis
• Jennifer Willis, QMHA
• Jessica Willis, MSW
• Kernan Willis
• Margaret Willis, LCSW
• Nicholas Andrew Willis

• General Practice Dentistry in Portland, OR
• Providers in Portland, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2011; 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.