Active NPI
Scott Cabot Willis, PH.D.
- Clinical Psychologist
- Tigard, OR
National Provider Identifier
1679566848
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 919
- Practice address
- 7157 SW Beveland Rd
Suite 100
Tigard, OR 97223-9628 - Phone
- (503) 547-9505
- NPI assigned
- Aug 23, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 919 | OR | Primary |
Addresses
Primary practice location
7157 SW Beveland Rd
Suite 100
Tigard, OR 97223-9628
Mailing address
7157 SW Beveland Rd
Suite 100
Tigard, OR 97223-9628
Phone (503) 547-9505
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 042494 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1989
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
7157 SW Beveland Rd
Suite 100
Tigard, OR 97223-9628
Phone (503) 547-9505
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
Organizations & group practices 1
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.
-
- Clinical Psychologist
- Tigard, OR
- NPI 1962636860
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358380800000",
"number": "1679566848",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7157 SW BEVELAND RD",
"address_2": "SUITE 100",
"city": "TIGARD",
"state": "OR",
"postal_code": "972239628",
"telephone_number": "503-547-9505"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7157 SW BEVELAND RD",
"address_2": "SUITE 100",
"city": "TIGARD",
"state": "OR",
"postal_code": "972239628",
"telephone_number": "503-547-9505"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "SCOTT",
"middle_name": "CABOT",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-23",
"last_updated": "2013-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "919",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "042494",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tigard, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2013; 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.