Active NPI
John Robert Willcockson, M.D.
- Ophthalmology Physician
- Cave Creek, AZ
National Provider Identifier
1750384715
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 0840
- Practice address
- 35025 N. El Sendero Rd
Cave Creek, AZ 85331 - Phone
- (605) 661-8495
- Fax
- (605) 665-0526
- NPI assigned
- May 24, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 17563 | NE | |
| Ophthalmology Physician | 207W00000X | 0840 | SD | Primary |
Addresses
Primary practice location
35025 N. El Sendero Rd
Cave Creek, AZ 85331
Mailing address
35025 N. El Sendero Rd
Cave Creek, AZ 85331
Phone (605) 661-8495
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 36-305015-14 | Medicaid | NE | |
| 36-3050195-12 | Medicaid | NE | |
| 0001010 | Other | SD | SD WELLMARK BLUE SHIELD I |
| 840 | Other | SD | DAKOTACARE PROVIDER ID |
| 6300040 | Medicaid | SD | |
| 36-3050195-18 | Medicaid | NE | |
| 22051 | Other | NE | NE BLUE SHIELD ID |
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 840 | SD | MD | Sports Physician Chiropractor |
| 17563 | NE | MD | Ophthalmology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Willcockson Eye Associates, P.C. | Ophthalmology | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Ophthalmology Physician
- Yankton, SD
- NPI 1992802920
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1116892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1569888000000",
"number": "1750384715",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "35025 N. EL SENDERO RD",
"city": "CAVE CREEK",
"state": "AZ",
"postal_code": "85331",
"telephone_number": "605-661-8495",
"fax_number": "605-665-0526"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "35025 N. EL SENDERO RD",
"city": "CAVE CREEK",
"state": "AZ",
"postal_code": "85331",
"telephone_number": "605-661-8495",
"fax_number": "605-665-0526"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLCOCKSON",
"first_name": "JOHN",
"middle_name": "ROBERT",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-05-24",
"last_updated": "2019-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "NE",
"license": "17563",
"primary": false
},
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "SD",
"license": "0840",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "36-305015-14",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "36-3050195-12",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SD WELLMARK BLUE SHIELD I",
"identifier": "0001010",
"state": "SD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DAKOTACARE PROVIDER ID",
"identifier": "840",
"state": "SD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6300040",
"state": "SD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "36-3050195-18",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NE BLUE SHIELD ID",
"identifier": "22051",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cave Creek, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.