Cedric R Willis, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA.200392 Issued in LA

Practice address

8001 Youree Dr Ste 540
Shreveport, LA 71115-2343

Phone

(318) 631-9121

Fax

(318) 631-9126

NPI assigned

Oct 27, 2010

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 LA

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

Physician Assistant

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gastrointestinal Specialists AMCGroup PAC ID 0547245086, 32 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Willis Knighton Medical Center Hospital, Shreveport, LA, CCN 190111

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Gastrointestinal Specialists, a.M.C.

  • Gastroenterology Physician
  • Shreveport, LA
  • NPI 1932171725
  Medicare reassignment Care Compare group
• Capitol City Family Health Center Incorporated

  • Federally Qualified Health Center (FQHC)
  • Baton Rouge, LA
  • NPI 1265548614
  Medicare reassignment NPD
• Capitol City Family Health Center, Incorporated

  • Federally Qualified Health Center (FQHC)
  • Baton Rouge, LA
  • NPI 1720965767
  NPD
• Capitol City Family Health Center, Incorporated

  • Federally Qualified Health Center (FQHC)
  • Shreveport, LA
  • NPI 1962154542
  NPD
• Winn Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Ruston, LA
  • NPI 1447133459
  NPD
• Winn Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Ringgold, LA
  • NPI 1962882191
  NPD

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

• Willis Knighton Medical Center, Inc.

  • General Acute Care Hospital
  • Bossier City, LA
  • NPI 1003968579
  Care Compare affiliation
• Willis Knighton Medical Center, Inc.

  • General Acute Care Hospital
  • Shreveport, LA
  • NPI 1124170691
  Care Compare affiliation
• Willis Knighton Medical Center, Inc.

  • General Acute Care Hospital
  • Shreveport, LA
  • NPI 1275685539
  Care Compare affiliation
• Willis Knighton Medical Center, Inc.

  • General Acute Care Hospital
  • Shreveport, LA
  • NPI 1568461572
  Care Compare affiliation

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

{
    "created_epoch": "1288137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660262400000",
    "number": "1801196589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3217 MABEL ST",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034022",
            "telephone_number": "318-631-9121",
            "fax_number": "318-631-9126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8001 YOUREE DR STE 540",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711152343",
            "telephone_number": "318-631-9121",
            "fax_number": "318-631-9126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "CEDRIC",
        "middle_name": "R",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-10-27",
        "last_updated": "2022-08-12",
        "certification_date": "2022-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "LA",
            "license": "PA.200392",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "PA.200392",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2128680",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Willis-Knighton Medical Center, Inc.
• Willis-Knighton Medical Center, Inc.
• Willis-Knighton Medical System
• Brandy Willis
• Brian Keith Willis, M.D.
• Chase Kylen Willis
• Cindy L Willis, LPC
• Darien Willis
• Diamond Marie Willis
• Elizabeth Reaves Willis, NP

• Physician Assistant in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Physician Assistant in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 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.