NPIMap

Individual provider Active NPI

Charles J Willey, MD

  • Specialist
  • Saint Louis, MO
National Provider Identifier
1811996028
Registry record updated Jul 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
13351 Issued in MO
Practice address
9915 Kennerly Rd
Suite J
Saint Louis, MO 63128-2703
Phone
(314) 843-4794
Fax
(314) 843-9256
NPI assigned
Jul 19, 2005
Reactivated
Jun 20, 2006
Last updated
Jul 15, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 13351 MO Primary

Addresses

Primary practice location

9915 Kennerly Rd
Suite J
Saint Louis, MO 63128-2703

Mailing address

9915 Kennerly Rd
Suite J
Saint Louis, MO 63128-2703
Phone (314) 843-4794

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20071203000615 MO Practitioner - Internal Medicine 0244205615 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Washington University School of Medicine, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aging Well Health Care, LLCGroup PAC ID 1153232038, 236 clinicians
CJW Enterprises, IncGroup PAC ID 9537293816, 5 clinicians

Practice addresses (Care Compare)

7212 Balson Ave
Saint Louis, MO 63130-3001

9915 Kennerly Rd J
Saint Louis, MO 63128-2703
Phone (314) 843-4794

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
13351MOMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
All Facility Management Group, LLC Current Accepting new patients
American Multispecialty Group Inc. CurrentSince Aug 6, 1996 Accepting new patients
Washington University Past Accepting new patients

Locations

2900 Frank Scott Pkwy W
Ste 914
Belleville, IL 62223
Phone (618) 277-1413

1167 Fortune Blvd
Shiloh, IL 62269
Phone (618) 207-6900

1475 Kisker Rd
Ste 230
Saint Charles, MO 63304
Phone (636) 939-5000

9915 Kennerly Rd
Ste J
Saint Louis, MO 63128
Phone (314) 843-4794

9930 Watson Rd
Saint Louis, MO 63126
Phone (314) 984-8827

Interoperability endpoints

  • Direct secure messaging: charleswilley@ihadv.allscriptsdirect.net
  • Direct secure messaging: plancaster01@direct.lumeris.com

Organizations & group practices 5

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 11

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": "1121731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279152000000",
    "number": "1811996028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9915 KENNERLY RD",
            "address_2": "SUITE J",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282703",
            "telephone_number": "314-843-4794",
            "fax_number": "314-843-9256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9915 KENNERLY RD",
            "address_2": "SUITE J",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282703",
            "telephone_number": "314-843-4794",
            "fax_number": "314-843-9256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLEY",
        "first_name": "CHARLES",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-19",
        "last_updated": "2010-07-15",
        "deactivation_date": "2006-03-20",
        "reactivation_date": "2006-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MO",
            "license": "13351",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.