Shelby Madolyn Willis, DO

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

7288 Issued in OK

Practice address

3401 W Gore Blvd
Lawton, OK 73505-6332

Phone

(580) 585-5545

NPI assigned

May 7, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OK, TX2 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 2

Specialty

Emergency Medicine

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Grady Memorial HospitalGroup PAC ID 0648175778, 47 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension St John Broken Arrow Hospital, Broken Arrow, OK, CCN 370235
• St John Owasso Hospital, Owasso, OK, CCN 370227

Merit-based Incentive Payment System (MIPS)

Final score

90.91 of 100Reported as apm

Quality

76.55

Promoting interoperability

100

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

85.12 of 100Reported as group

Quality

83.76

Promoting interoperability

100

Improvement activities

40

Cost

56.64

Merit-based Incentive Payment System (MIPS)

Final score

93.51 of 100Reported as group

Quality

84.87

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: swillis20819@muscogeecreeknation.direct-ci.com

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.

• Grady Memorial Hospital

  • Anesthesiology Physician
  • Chickasha, OK
  • NPI 1750370268
  Medicare reassignment Care Compare group NPD
• Creek Nation Hospital & Clinics

  • Clinic/Center
  • Muskogee, OK
  • NPI 1366593923
  Medicare reassignment NPD
• Emergency Medicine Physicians of Tulsa County, LLC

  • Emergency Medicine Physician
  • Tulsa, OK
  • NPI 1003098773
  Medicare reassignment NPD
• South Central Emergency Services PC

  • Emergency Medicine Physician
  • Stillwater, OK
  • NPI 1558663724
  Medicare reassignment NPD
• St. John Physicians, Inc.

  • Internal Medicine Physician
  • Tulsa, OK
  • NPI 1336194406

  Emergency Medicine

  Medicare reassignment NPD
• Creek Nation Hospital & Clinics

  • Family Medicine Physician
  • Okemah, OK
  • NPI 1467053173

  TX

  Medicare reassignment
• Creek Nation Hospital & Clinics

  • Rehabilitation Hospital
  • Okmulgee, OK
  • NPI 1891197224
  NPD
• Grady Memorial Hospital

  • Rural Health Clinic/Center
  • Tuttle, OK
  • NPI 1750715439
  NPD
• Grady Memorial Hospital

  • General Acute Care Hospital
  • Chickasha, OK
  • NPI 1992854590
  NPD
• St. John Physicians, Inc

  • Rural Health Clinic/Center
  • Barnsdall, OK
  • NPI 1033176367
  NPD
• Owasso Medical Facility, Inc

  • General Acute Care Hospital
  • Owasso, OK
  • NPI 1144231432
  NPD (past)
• St. John Broken Arrow, Inc

  • General Acute Care Hospital
  • Broken Arrow, OK
  • NPI 1497988596
  NPD (past)

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

• Owasso Medical Facility, Inc

  • General Acute Care Hospital
  • Owasso, OK
  • NPI 1144231432
  Care Compare affiliation
• St. John Broken Arrow, Inc

  • General Acute Care Hospital
  • Broken Arrow, OK
  • NPI 1497988596
  Care Compare affiliation

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

{
    "created_epoch": "1588809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661472000000",
    "number": "1730701251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 W GORE BLVD",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735056332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 W GORE BLVD",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735056332",
            "telephone_number": "580-585-5545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "SHELBY",
        "middle_name": "MADOLYN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-07",
        "last_updated": "2022-08-26",
        "certification_date": "2022-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OK",
            "license": "7288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Williams
• Tammar Williams
• Theleka Williams, APRN-CNP
• Trevor Williams
• Sania Michelle Williamson
• Rylee Willmon, RBT
• Susan Elizabeth Willmon
• Lisa Carolin Wilmeth, NP
• Airianna Wilson
• Ashley Nicole Wilson, COTA

• Emergency Medicine Physician in Lawton, OK
• Providers in Lawton, OK by specialty
• Emergency Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2022; 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.