NPIMap

Individual provider Active NPI

Stuart Kendall Willis III, MD

  • Emergency Medicine Physician
  • Bonners Ferry, ID
National Provider Identifier
1679649396
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
M9300 Issued in ID
Practice address
6640 Kaniksu St
Bonners Ferry, ID 83805-7532
Phone
(208) 267-4850
Fax
(208) 267-2202
NPI assigned
Nov 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X M9300 ID Primary

Addresses

Primary practice location

6640 Kaniksu St
Bonners Ferry, ID 83805-7532

Mailing address

HCR 85 Box 8133
Bonners Ferry, ID 83805-7532
Phone (208) 267-6365

Other identifiers 1

IdentifierTypeStateIssuer
M9300OtherIDID B OF M

Other names 1

  • Henry Stuart Kendall Willis III Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M9300IDMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sierra Vista Hospital Past Accepting new patients
Memorial Hospital Past Accepting new patients
Sierra Vista Hospital Past Accepting new patients
Unm Medical Group Inc Past Accepting new patients
Vista Emergency Physicians LLC Emergency Medicine Past Accepting new patients

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1679649396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "HCR 85 BOX 8133",
            "city": "BONNERS FERRY",
            "state": "ID",
            "postal_code": "838057532",
            "telephone_number": "208-267-6365",
            "fax_number": "208-267-2202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6640 KANIKSU ST",
            "city": "BONNERS FERRY",
            "state": "ID",
            "postal_code": "838057532",
            "telephone_number": "208-267-4850",
            "fax_number": "208-267-2202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "STUART",
        "middle_name": "KENDALL",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-27",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "ID",
            "license": "M9300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ID B OF M",
            "identifier": "M9300",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HENRY",
            "last_name": "WILLIS",
            "middle_name": "STUART KENDALL",
            "suffix": "III",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bonners Ferry, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.