NPIMap

Individual provider Active NPI

Sean Dustin Willis, DO

  • Surgery Physician
  • Rockville Centre, NY
National Provider Identifier
1710484910
Registry record updated Aug 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
321467 Issued in NY
Practice address
2000 N Village Ave Ste 211
Rockville Centre, NY 11570-1001
Phone
(516) 714-3743
NPI assigned
Apr 12, 2018
Last updated
Aug 18, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 321467 NY Primary
Surgical Critical Care Physician 2086S0102X 321467 NY
Trauma Surgery Physician 2086S0127X OS20663 FL

Addresses

Primary practice location

2000 N Village Ave Ste 211
Rockville Centre, NY 11570-1001

Mailing address

PO Box 100108
Gainesville, FL 32610-0108
Phone (352) 265-0535

Other practice location 1

311 N Clyde Morris Blvd
Daytona Beach, FL 32114-2781
Phone (386) 241-1020

Other practice location 2

43 New Scotland Ave
Albany, NY 12208-3412
Phone (518) 262-3125

Other practice location 3

1600 SW Archer Rd
Gainesville, FL 32610-2545
Phone (352) 265-0535

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, NY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240404003046 FL Practitioner - General Surgery 3870931116 Reassigns benefits to 1 organization
I20250826004836 NY Practitioner - General Surgery 3870931116 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Nova Southeastern College of Osteo Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Long Island Surgical PLLCGroup PAC ID 8628305786, 9 clinicians
Acute Care Medical Services PLLCGroup PAC ID 8820477250, 8 clinicians

Practice addresses (Care Compare)

2000 N Village Ave
Suite 211
Rockville Centre, NY 11570-1001
Phone (516) 900-7922

2001 SW 13TH St
Gainesville, FL 32608-1532
Phone (352) 265-8990

303 N Clyde Morris Blvd
Halifax Health
Daytona Beach, FL 32114-2709
Phone (386) 425-4000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Melanoma (skin cancer) excision1-10
Removal of tissue1-10
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
321467NYMDSurgical Critical Care Physician
OS20663FLMDTrauma Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Clinical Practice Association Inc Surgery CurrentSince Mar 1, 2024 Accepting new patients
Acute Care Medical Services PLLC Surgery CurrentSince Aug 18, 2025 Accepting new patients
Long Island Surgical PLLC Surgery CurrentSince Aug 18, 2025 Accepting new patients
Florida Clinical Practice Association Inc CurrentSince Mar 1, 2024 Accepting new patients
Mercy Medical Center Past Accepting new patients

Locations

311 N Clyde Morris Blvd
Daytona Beach, FL 32114
Phone (386) 241-1020

1600 SW Archer Rd
Gainesville, FL 32610
Phone (352) 265-0077

2001 SW 13th St
Gainesville, FL 32608
Phone (352) 265-8990

4271 Hempstead Tpke
Ste 211
Bethpage, NY 11714
Phone (516) 900-7922

2000 N Village Ave
Ste 211
Rockville Ctr, NY 11570
Phone (516) 764-1303

Interoperability endpoints

  • Direct secure messaging: swillis30818@albanymed.direct-ci.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1523491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755475200000",
    "number": "1710484910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100108",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326100108",
            "telephone_number": "352-265-0535",
            "fax_number": "352-627-4173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 N VILLAGE AVE STE 211",
            "city": "ROCKVILLE CENTRE",
            "state": "NY",
            "postal_code": "115701001",
            "telephone_number": "516-714-3743"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "311 N Clyde Morris Blvd",
            "address_purpose": "LOCATION",
            "city": "Daytona Beach",
            "state": "FL",
            "postal_code": "321142781",
            "country_code": "US",
            "telephone_number": "386-241-1020",
            "fax_number": "386-241-1022",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "43 New Scotland Ave",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "NY",
            "postal_code": "122083412",
            "country_code": "US",
            "telephone_number": "518-262-3125",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1600 SW Archer Rd",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "FL",
            "postal_code": "326102545",
            "country_code": "US",
            "telephone_number": "352-265-0535",
            "fax_number": "352-627-4173",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "SEAN",
        "middle_name": "DUSTIN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-12",
        "last_updated": "2025-08-18",
        "certification_date": "2025-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NY",
            "license": "321467",
            "primary": true
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "NY",
            "license": "321467",
            "primary": false
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "FL",
            "license": "OS20663",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville Centre, NY

Sources for this page

Verify at the official NPI Registry.