Carlene Willis, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95008027 Issued in CA

Practice address

264 N Highland Springs Ave Ste 4
Banning, CA 92220-3082

Phone

(951) 769-0079

NPI assigned

Dec 19, 2017

Sex

Female

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 CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Faculty Physicians and Surgeons of LlusmGroup PAC ID 1153227814, 1,313 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Loma Linda University Medical Center Hospital, Loma Linda, CA, CCN 050327

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: carlene.willis.p1@direct.dvmg.nextgenshare.com
• Direct secure messaging: cwillis80495@direct.llu.edu

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.

• Faculty Physicians and Surgeons of Llusm

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Apple Valley, CA
  • NPI 1205009917
  Medicare reassignment Care Compare group NPD
• Desert Valley Medical Group, Inc.

  • Physical Therapist
  • Victorville, CA
  • NPI 1639117864
  Medicare reassignment NPD
• Southern California Emergency Medicine

  • Urgent Care Clinic/Center
  • San Bernardino, CA
  • NPI 1639314255
  Medicare reassignment NPD
• Desert Valley Medical Group, Inc

  • Internal Medicine Physician
  • Victorville, CA
  • NPI 1952020315
  NPD
• Desert Valley Medical Group, Inc.

  • Internal Medicine Physician
  • Victorville, CA
  • NPI 1801848452
  NPD
• Faculty Physicians and Surgeons of Llusm

  • Family Medicine Physician
  • Moreno Valley, CA
  • NPI 1558788331
  NPD
• Faculty Physicians and Surgeons of Llusm

  • Family Medicine Physician
  • Redlands, CA
  • NPI 1679043400
  NPD
• Southern California Emergency Medicine

  • Urgent Care Clinic/Center
  • Riverside, CA
  • NPI 1063191575
  NPD
• Southern California Emergency Medicine

  • Urgent Care Clinic/Center
  • Redlands, CA
  • NPI 1457888034
  NPD
• Faculty Physicians and Surgeons of Llusm

  • Orthopaedic Surgery Physician
  • Loma Linda, CA
  • NPI 1275582918
  NPD (past)
• Loma Linda University Medical Center

  • General Acute Care Hospital
  • Loma Linda, CA
  • NPI 1194731935
  NPD (past)
• Neighborhood Healthcare

  • Federally Qualified Health Center (FQHC)
  • Beaumont, CA
  • NPI 1629601653
  NPD (past)

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

• Loma Linda University Medical Center

  • General Acute Care Hospital
  • Loma Linda, CA
  • NPI 1194731935
  Care Compare affiliation

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

{
    "created_epoch": "1513641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513641600000",
    "number": "1740796358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "264 N HIGHLAND SPRINGS AVE STE 4",
            "city": "BANNING",
            "state": "CA",
            "postal_code": "922203082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "264 N HIGHLAND SPRINGS AVE STE 4",
            "city": "BANNING",
            "state": "CA",
            "postal_code": "922203082",
            "telephone_number": "951-769-0079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "CARLENE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-19",
        "last_updated": "2017-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95008027",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Glen Wiley, APRN, FNP-C
• Brittany Williams
• Cameo Williams
• John Gavin Williams, M.D
• Brigitte Yvonne Willis, M.D., PH.D.
• Celina Beatriz Wong Miller, MD
• Sam Duane Worrall
• Louis Charles Wright III
• Ting Wu, M.D.
• Vanessa Wyche, LCSW

• Family Nurse Practitioner in Banning, CA
• Providers in Banning, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2017; 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.