Willis W Stevenson III, MD

Primary specialty

Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X

License

01062348A Issued in IN

Practice address

2310 California Road
Elkhart, IN 46514-1228

Phone

(574) 264-4163

Fax

(574) 262-9650

NPI assigned

Jan 18, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IN

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 1

Specialty

Sports MedicineAlso: Orthopedic Surgery

Education

University of Pittsburgh School of Medicine, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Orthopedic and Sports Medicine Center of Northern Indiana IncGroup PAC ID 0840260105, 46 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Elkhart General Hospital Hospital, Elkhart, IN, CCN 150018
• Goshen Hospital Hospital, Goshen, IN, CCN 150026

Merit-based Incentive Payment System (MIPS)

Final score

81.85 of 100Reported as group

Quality

59.71

Promoting interoperability

90

Improvement activities

40

Cost

88.11

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: willis.stevenson@direct.osmc.nextgenshare.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.

• Orthopedic and Sports Medicine Center of Northern Indiana, Inc

  • Orthopaedic Surgery Physician
  • Elkhart, IN
  • NPI 1710085253
  Medicare reassignment Care Compare group
• ASC Surgical Ventures, LLC

  • Ambulatory Surgical Clinic/Center
  • Elkhart, IN
  • NPI 1083715148
  NPD (past)

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

• Elkhart General Hospital, Inc.

  • General Acute Care Hospital
  • Elkhart, IN
  • NPI 1477551489
  Care Compare affiliation
• Goshen Hospital Association Inc

  • General Acute Care Hospital
  • Goshen, IN
  • NPI 1740268846
  Care Compare affiliation

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1780736645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2310 CALIFORNIA ROAD",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465141228",
            "telephone_number": "574-264-4163",
            "fax_number": "574-262-9650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2310 CALIFORNIA ROAD",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465141228",
            "telephone_number": "574-264-4163",
            "fax_number": "574-262-9650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEVENSON",
        "first_name": "WILLIS",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-18",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "IN",
            "license": "01062348A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "01062348A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200847880",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeffrey E Steele, DDS
• Shannon Steinhauer
• La-Rena Maria Steinhaus, RN
• Naomi Sterling, BS
• Lyn Marie Stevens, NP
• Nautica Steward
• John Richard Stewart, D.D.S.
• Quinn Andrew Stillson, MD
• Reed Stockman, CRNA
• Elizabeth Marie Stockwell, AUD

• Sports Medicine (Orthopaedic Surgery) Physician in Elkhart, IN
• Providers in Elkhart, IN by specialty
• Sports Medicine (Orthopaedic Surgery) Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.