Jason Willis, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

29655 Issued in OK

Practice address

1101 12TH Ave, NW
Mercy Ardmore Hospital Wound Care Center
Ardmore, OK 73401

Phone

(580) 220-6290

NPI assigned

Mar 6, 2007

Last updated

Oct 19, 2015By 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 OK, TX, HI3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 3

Specialty

Internal Medicine

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kagman Community Health Center IncGroup PAC ID 6002171659, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jwillis712189@directa.mercy.net

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.

• Healogics Specialty Physicians of Oklahoma, PLLC

  • Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
  • Lawton, OK
  • NPI 1144625740

  Internal Medicine

  Medicare reassignment NPD
• Mercy Clinic Oklahoma Communities

  • Family Medicine Physician
  • Oklahoma City, OK
  • NPI 1386874550

  Internal Medicine

  Medicare reassignment NPD
• Eagle Butte Indian Health Service Hospital

  • Public Health or Welfare Agency
  • Eagle Butte, SD
  • NPI 1558395848

  TX

  Medicare reassignment NPD
• Access 360 Care Inc

  dba NTX 360 Care

  • Internal Medicine Physician
  • Arlington, TX
  • NPI 1962156802
  Medicare reassignment
• Kagman Community Health Center Inc

  dba Kagman Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Saipan, MP
  • NPI 1770002446
  Care Compare group
• MMC & Pacific Labs, LLC

  • Family Medicine Physician
  • Saipan, MP
  • NPI 1588208862
  NPD
• Cogent Healthcare of Montana P C

  • Internal Medicine Physician
  • Missoula, MT
  • NPI 1053569525
  NPD (past)

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445212800000",
    "number": "1679603153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 848371",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022848371",
            "telephone_number": "580-920-9000",
            "fax_number": "580-920-9159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 12TH AVE, NW",
            "address_2": "MERCY ARDMORE HOSPITAL WOUND CARE CENTER",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "73401",
            "telephone_number": "580-220-6290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "JASON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-06",
        "last_updated": "2015-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OK",
            "license": "29655",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meredith Dawn Williams, LPC-CANDIDATE
• Patrick Kelly Williams
• Shannon Williams
• Lasharron D Williamson
• Alli Willis
• Tatum Willis
• Ashley Wilson
• Bethany Wilson
• Lindsay Anne Wilson, D.O.
• Lyndsie Machele Wilson

• Internal Medicine Physician in Ardmore, OK
• Providers in Ardmore, OK by specialty
• Internal Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2015; 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.