NPIMap

Individual provider Active NPI

Kirk Ellsworth Willard, MD

  • Orthopaedic Surgery Physician
  • Walla Walla, WA
National Provider Identifier
1669486072
Registry record updated Apr 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
MD00037859 Issued in WA
Practice address
380 Chase Ave
Orthopaedics
Walla Walla, WA 99362-2924
Phone
(509) 522-5820
Fax
(509) 522-5570
NPI assigned
Jul 28, 2006
Last updated
Apr 29, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X MD00037859 WA Primary

Addresses

Primary practice location

380 Chase Ave
Orthopaedics
Walla Walla, WA 99362-2924

Mailing address

PO Box 34439
Seattle, WA 98124-1439

Other identifiers 2

IdentifierTypeStateIssuer
134448MedicaidOR
1669486072MedicaidWA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kwillard186008@wm.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090128000211 WA Practitioner - Orthopedic Surgery 9931263423 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Loma Linda University School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

380 Chase Ave
Walla Walla, WA 99362-2924
Phone (509) 897-3333

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement71
Knee replacement40
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD00037859WAMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Washington CurrentSince Jan 1, 2009 Accepting new patients
Providence Health & Services - Washington Orthopaedic Surgery CurrentSince Jan 1, 2009 Accepting new patients
Providence Health & Services - Washington Past Accepting new patients

Locations

380 Chase Ave
Walla Walla, WA 99362
Phone (509) 526-3333

401 W Poplar St
Walla Walla, WA 99362
Phone (509) 522-5731

Interoperability endpoints

  • Direct secure messaging: kwillard186008@wm.providencedirect.org

Organizations & group practices 3

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619654400000",
    "number": "1669486072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 34439",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981241439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 CHASE AVE",
            "address_2": "ORTHOPAEDICS",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993622924",
            "telephone_number": "509-522-5820",
            "fax_number": "509-522-5570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLARD",
        "first_name": "KIRK",
        "middle_name": "ELLSWORTH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2021-04-29",
        "certification_date": "2021-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "WA",
            "license": "MD00037859",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "134448",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1669486072",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kwillard186008@wm.providencedirect.org",
            "affiliation": "N",
            "address_1": "380 Chase Ave",
            "city": "Walla Walla",
            "state": "WA",
            "country_code": "US",
            "postal_code": "993622924",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Walla Walla, WA

Sources for this page

Verify at the official NPI Registry.