Charles Adam Willis, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

18377 Issued in TN

Practice address

6419 Bristol Hwy
Piney Flats, TN 37686-5208

Phone

(423) 538-5202

Fax

(423) 538-8208

NPI assigned

Feb 5, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Health ExpressGroup PAC ID 5799072963, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: charles.willis.1@10158.direct.athenahealth.com

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.

• Health Express

  • Urgent Care Clinic/Center
  • Greeneville, TN
  • NPI 1417352618
  Medicare reassignment Care Compare group
• Health Express Inc

  • Family Medicine Physician
  • Jonesboro, LA
  • NPI 1548477474
  NPD (past)

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

{
    "created_epoch": "1391558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488240000000",
    "number": "1659795151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6419 BRISTOL HWY",
            "city": "PINEY FLATS",
            "state": "TN",
            "postal_code": "376865208",
            "telephone_number": "423-538-5202",
            "fax_number": "423-538-8208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6419 BRISTOL HWY",
            "city": "PINEY FLATS",
            "state": "TN",
            "postal_code": "376865208",
            "telephone_number": "423-538-5202",
            "fax_number": "423-538-8208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "CHARLES",
        "middle_name": "ADAM",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-02-05",
        "last_updated": "2017-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TN",
            "license": "RN0000177156",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "18377",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q003839",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karrie Brooke Vance, PHARM D
• Eden Marie Villiard, FNP
• Walgreen Co
• Waymakerz Ministries Inc
• Wellmont Medical Associates Inc
• Caroline Hunter Wines, MS, CCC-SLP
• Sheri Denise Wingate, D.C.
• Timothy R Zeolia, PA

• Family Nurse Practitioner in Piney Flats, TN
• Providers in Piney Flats, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2017; 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.

Verify at the official NPI Registry.