Blake Krefton Willis, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

LL 34844 Issued in SC

Practice address

169 Ashley Ave
Charleston, SC 29425-8908

Phone

(843) 792-1414

NPI assigned

Jun 20, 2012

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

Medicare fee-for-service enrollment

Enrolled in SC, GA2 enrollments

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 2

Specialty

Emergency Medicine

Education

Medical College of Georgia School of Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Acs Primary Care Physicians - Southeast PCGroup PAC ID 5193620714, 409 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Fairview Park Hospital Hospital, Dublin, GA, CCN 110125

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 and National Provider Directory roles.

• Acs Primary Care Physicians - Southeast PC

  • Emergency Medicine Physician
  • Myrtle Beach, SC
  • NPI 1861430555

  GA

  Medicare reassignment Care Compare group NPD
• Bon Secours St Francis Xavier Hospital, Inc.

  • Emergency Medicine Physician
  • Charleston, SC
  • NPI 1770867442
  Medicare reassignment NPD
• Prisma Health-Midlands

  • General Acute Care Hospital
  • Columbia, SC
  • NPI 1205889458
  Medicare reassignment NPD
• Roper Hospital Inc

  • Emergency Medicine Physician
  • Moncks Corner, SC
  • NPI 1104983055
  Medicare reassignment NPD
• Roper St. Francis Mount Pleasant Hospital

  • Cardiovascular Disease Physician
  • Mt Pleasant, SC
  • NPI 1629499298
  Medicare reassignment NPD
• Sound Physicians Emergency Medicine of South Carolina LLC

  • Emergency Medicine Physician
  • Aiken, SC
  • NPI 1730636168
  Medicare reassignment NPD
• Bon Secours St. Francis Xavier Hospital, Inc.

  • Pediatrics Physician
  • Charleston, SC
  • NPI 1982583068
  NPD
• Prisma Health-Midlands

  • Emergency Medicine Physician
  • Columbia, SC
  • NPI 1639590680
  NPD
• Roper Hospital Inc

  • Emergency Medicine Physician
  • North Charleston, SC
  • NPI 1700943644
  NPD
• Roper Hospital Inc.

  • Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
  • N. Charleston, SC
  • NPI 1104563758
  NPD
• Roper St. Francis Mount Pleasant Hospital

  • Critical Care Medicine (Internal Medicine) Physician
  • Mt Pleasant, SC
  • NPI 1578362232
  NPD
• Roper St. Francis Mount Pleasant Hospital

  • Emergency Medicine Physician
  • Mount Pleasant, SC
  • NPI 1649587270
  NPD

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

• Fairview Park, Limited Partnership

  • General Acute Care Hospital
  • Dublin, GA
  • NPI 1285688234
  Care Compare affiliation

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

{
    "created_epoch": "1340150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435708800000",
    "number": "1841553328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751461",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751461",
            "telephone_number": "843-792-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 ASHLEY AVE",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294258908",
            "telephone_number": "843-792-1414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "BLAKE",
        "middle_name": "KREFTON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-20",
        "last_updated": "2015-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "SC",
            "license": "LL 34844",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tamekia Williamson
• Lauren Willingham
• Allison Burrell Willis, MD
• Ashlea Willis, DMD
• Austin Willis
• Edith Barrett Willis, PA-C
• Lindsey Dill Willis, MSN, FNP-BC
• Virginia A Willis, RPH
• Lisa Willmuth, CCC
• Ira R Willner, MD

• Emergency Medicine Physician in Charleston, SC
• Providers in Charleston, SC by specialty
• Emergency Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2015; 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.