Kerry Allen Willis, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

30580 Issued in NC

Practice address

1620 Live Oak St
Suite C
Beaufort, NC 28516

Phone

(252) 728-5737

Fax

(252) 728-5739

NPI assigned

Dec 29, 2005

Last updated

Dec 3, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

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

Family PracticeAlso: General Practice, Physical Medicine and Rehabilitation

Education

University of North Carolina at Chapel Hill School of Medicine, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Open Water Medical, PAGroup PAC ID 2961314315, 6 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Carteret Health Care Home Health and Hospice Home health agency, Morehead City, NC, CCN 347042
• Centerwell Home Health Home health agency, Morehead City, NC, CCN 347171
• Carteret General Hospital Hospital, Morehead City, NC, CCN 340142
• Unc Health Care Wayne Hospital, Goldsboro, NC, CCN 340010

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Open Water Medical, PA

  dba East Carteret Family Medicine

  • Primary Care Clinic/Center
  • Beaufort, NC
  • NPI 1750482493

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Open Water Medical, PA

  • Family Medicine Physician
  • Newport, NC
  • NPI 1699421065
  NPD

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

• Carteret County General Hospital Corporation

  dba Carteret Home Health Service

  • Home Health Agency
  • Morehead City, NC
  • NPI 1619943800
  Care Compare affiliation
• Carteret County General Hospital Corporation

  dba Carteret General Hospital

  • General Acute Care Hospital
  • Morehead City, NC
  • NPI 1760479331
  Care Compare affiliation
• Home Health Care of Carteret County, LLC

  dba CenterWell Home Health

  • Home Health Agency
  • Morehead City, NC
  • NPI 1528098324
  Care Compare affiliation
• Wayne Memorial Hospital Inc

  dba UNC Health Wayne

  • General Acute Care Hospital
  • Goldsboro, NC
  • NPI 1750353462
  Care Compare affiliation

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

{
    "created_epoch": "1135814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386028800000",
    "number": "1831176072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 LIVE OAK ST",
            "address_2": "SUITE C",
            "city": "BEAUFORT",
            "state": "NC",
            "postal_code": "28516",
            "telephone_number": "252-728-5737",
            "fax_number": "252-728-5739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 LIVE OAK ST",
            "address_2": "SUITE C",
            "city": "BEAUFORT",
            "state": "NC",
            "postal_code": "28516",
            "telephone_number": "252-728-5737",
            "fax_number": "252-728-5739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "KERRY",
        "middle_name": "ALLEN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-29",
        "last_updated": "2013-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "30580",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8988112",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William S Harvey III DDS 12 PLLC (ENC Prosthodontics)
• William S. Harvey III DDS3 PLLC (Beaufort Dental)
• Amanda L Williams, FNP
• Jeffrey Williams, RPH
• Susan Williams
• Mark B Wise, PT

• Family Medicine Physician in Beaufort, NC
• Providers in Beaufort, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2013; 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.