Derek M Wills

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

AMD-1213 Issued in HI

Practice address

480 Central Ave BLDG 1750
Jbphh, HI 96860-4908

Phone

(808) 474-4242

NPI assigned

Mar 2, 2010

Last updated

Jul 27, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1267488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690416000000",
    "number": "1841513157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "480 CENTRAL AVE BLDG 1750",
            "city": "JBPHH",
            "state": "HI",
            "postal_code": "968604908",
            "telephone_number": "808-474-4242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 CENTRAL AVE BLDG 1750",
            "city": "JBPHH",
            "state": "HI",
            "postal_code": "968604908",
            "telephone_number": "808-474-4242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLS",
        "first_name": "DEREK",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-03-02",
        "last_updated": "2023-07-27",
        "certification_date": "2023-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "1902",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "HI",
            "license": "AMD-1213",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Lee Watterson, PHARM.D.
• Debra Karlene Weinberg Newton, BSN RN
• Mackenzie White, R.D.
• Rachael White, R.N
• Karen Mika Widman, RN
• Peyton Wong, PHARM.D.
• Ian Michael Wright, PT
• Robert Usher Wright Jr., MD
• Joshua Yahalom, DPT
• Carrie P Yamamoto, RN

• Physician Assistant in Jbphh, HI
• Providers in Jbphh, HI by specialty
• Physician Assistant in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.