Willis Smith, APRN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

95017534 Issued in CA

Practice address

751 Lombardi CT
Santa Rosa, CA 95407-6798

Phone

(707) 303-6000

NPI assigned

Jan 29, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TN, CA2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Vanderbilt University School of Medicine, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Alliance Medical CenterGroup PAC ID 3779471446, 42 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Alliance Medical Center

  • Federally Qualified Health Center (FQHC)
  • Healdsburg, CA
  • NPI 1750399796
  Medicare reassignment Care Compare group NPD
• Mindful Health Solutions a Professional Medical Corporation

  • Psychiatry Physician
  • San Francisco, CA
  • NPI 1881894483
  Medicare reassignment NPD
• Santa Rosa Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Santa Rosa, CA
  • NPI 1578631172
  Medicare reassignment NPD
• Harmony Health Medical Inc

  • Multi-Specialty Clinic/Center
  • Murfreesboro, TN
  • NPI 1992312094
  Medicare reassignment NPD
• Alliance Medical Center

  • Optometrist
  • Healdsburg, CA
  • NPI 1588497168
  NPD
• Alliance Medical Center

  • Federally Qualified Health Center (FQHC)
  • Windsor, CA
  • NPI 1710218409
  NPD
• Santa Rosa Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Santa Rosa, CA
  • NPI 1467180430
  NPD
• Santa Rosa Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Santa Rosa, CA
  • NPI 1780195255
  NPD
• Southwest Arkansas Counseling and Mental Health Center, Inc

  • Community/Behavioral Health Agency
  • Hope, AR
  • NPI 1295985208
  NPD (past)
• Southwest Arkansas Counseling and Mental Health Center, Inc

  • Community/Behavioral Health Agency
  • Texarkana, AR
  • NPI 1598761553
  NPD (past)
• Vanderbilt University

  • Clinical Social Worker
  • Nashville, TN
  • NPI 1285659706
  NPD (past)

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

{
    "created_epoch": "1422489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706832000000",
    "number": "1861882847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3841 GREEN HILLS VILLAGE DR STE 200",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372152691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 LOMBARDI CT",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954076798",
            "telephone_number": "707-303-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "WILLIS",
        "name_prefix": "Mr.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-01-29",
        "last_updated": "2024-02-02",
        "certification_date": "2024-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TN",
            "license": "28278",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95017534",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AR",
            "license": "P1701203",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "willissmith@marinclinic.org",
            "affiliation": "N",
            "address_1": "3260 Kerner Blvd",
            "city": "San Rafael",
            "state": "CA",
            "country_code": "US",
            "postal_code": "949014840",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ryan Alexander Smith, M.D.
• Steve Smith, PHARMD
• Steven Allen Smith, M.D.
• Tirin Smith
• Violet J Smith
• Jeanne Marie Smithfield-Straus, MFT
• Sharon Sneddon, NP
• Bradly Dee Snell, CADC II
• Lindsey Snetsinger
• Halie Snider

• Psychiatric/Mental Health Nurse Practitioner in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2024; 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.