NPIMap

Individual provider Active NPI

Darrell E Willis, MD

  • Family Medicine Physician
  • Tucumcari, NM
National Provider Identifier
1740235480
Registry record updated Feb 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME77630 Issued in FL
Practice address
402 E Miel de Luna Ave
Tucumcari, NM 88401-3828
Phone
(575) 461-7100
Fax
(575) 461-7101
NPI assigned
May 23, 2006
Last updated
Feb 13, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME77630 FL Primary

Addresses

Primary practice location

402 E Miel de Luna Ave
Tucumcari, NM 88401-3828

Mailing address

909 Escuela Ave
Tucumcari, NM 88401-4616
Phone (850) 376-6042

Other identifiers 1

IdentifierTypeStateIssuer
256613300MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110920000465 NM Practitioner - Family Practice 6406815364 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of South Alabama College of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Presbyterian Healthcare ServicesGroup PAC ID 9234041708, 1,390 clinicians

Practice addresses (Care Compare)

301 E Miel de Luna Ave
Tucumcari, NM 88401-3810
Phone (575) 461-7000

PO Box
Albuquerque, NM 87125-6666

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.68 of 100Reported as group
Quality
82.35
Promoting interoperability
100
Improvement activities
40
Cost
76.6

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Presbyterian Healthcare Services Family Medicine CurrentSince Aug 1, 2011 Accepting new patients
Presbyterian Healthcare Services CurrentSince Aug 1, 2011 Accepting new patients
Tri Hospital MRI Center Past Accepting new patients
Presbyterian Healthcare Services Past Accepting new patients
Wyoming Health Medical Group, LLC Past Accepting new patients
Sacred Heart Health System, Inc. Past Accepting new patients

Locations

4588 Paradise Blvd NW
Albuquerque, NM 87114
Phone (505) 923-2070

2100 N Mlk Blvd
Clovis, NM 88101
Phone (505) 769-2141

2200 W 21st St
Clovis, NM 88101
Phone (505) 769-7577

301 E Miel de Luna Ave
Tucumcari, NM 88401
Phone (575) 461-7000

301 E Miel de Luna Ave
#C
Tucumcari, NM 88401
Phone (505) 461-0141

402 E Miel de Luna Ave
Tucumcari, NM 88401
Phone (575) 461-1660

Interoperability endpoints

  • Direct secure messaging: dwillis37643@direct.phs.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Dr. Dan C. Trigg Memorial HospitalTucumcari, NM, CCN 321302 Hospital Other Jan 1, 2016

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 7

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 5

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": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1360713600000",
    "number": "1740235480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 ESCUELA AVE",
            "city": "TUCUMCARI",
            "state": "NM",
            "postal_code": "884014616",
            "telephone_number": "850-376-6042",
            "fax_number": "575-461-7101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 E MIEL DE LUNA AVE",
            "city": "TUCUMCARI",
            "state": "NM",
            "postal_code": "884013828",
            "telephone_number": "575-461-7100",
            "fax_number": "575-461-7101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "DARRELL",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2013-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME77630",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256613300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucumcari, NM

Sources for this page

Verify at the official NPI Registry.