Carol L Willis, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

OH44316 Issued in OH

Practice address

2810 Burnet Ave
Suite V
Cincinnati, OH 45219-2447

Phone

(513) 961-5080

Fax

(513) 861-0500

NPI assigned

Jan 13, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Apr 1, 2023 through Apr 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Tamara M. Campbell MD.,PSYD, Inc

  • Community/Behavioral Health Agency
  • Cincinnati, OH
  • NPI 1164750642
  NPD (past)

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

{
    "created_epoch": "1168646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211155200000",
    "number": "1831240340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2810 BURNET AVE",
            "address_2": "SUITE V",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452192447",
            "telephone_number": "513-961-5080",
            "fax_number": "513-861-0500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2810 BURNET AVE",
            "address_2": "SUITE V",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452192447",
            "telephone_number": "513-961-5080",
            "fax_number": "513-861-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "CAROL",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-13",
        "last_updated": "2008-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OH",
            "license": "OH44316",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "KY",
            "license": "KY31932",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0690659",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Telisha Leinsha Willingham
• Abriana Willis
• April R Willis
• Betty Latasha Willis
• Bonnie L Willis, QMHS
• Craig B. Willis, M.D.
• Earlene Fay Willis
• Eddie Willis Jr.
• Jaime B Willis, PSY.D.
• James B. Willis, M.D.

• Psychiatry Physician in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• Psychiatry Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2008; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.