Individual provider Active NPI

David William Willis, NP

  • Nurse Practitioner
  • Portsmouth, OH
National Provider Identifier
1881636736
Registry record updated Nov 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
279699 Issued in OH
Practice address
1805 27TH St
Portsmouth, OH 45662-2640
Phone
(740) 356-5000
NPI assigned
Jun 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 279699 OH Primary

Addresses

Primary practice location

1805 27TH St
Portsmouth, OH 45662-2640

Mailing address

2000 Green Rd
Suite 300
Ann Arbor, MI 48105-1598
Phone (740) 352-4127

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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

Enrollment IDStateProvider typePAC IDDetails
I20091211000380 OH Practitioner - Nurse Practitioner 3678613262 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
279699OHMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mid-Ohio Emergency Services, LLC Nurse Practitioner CurrentSince Dec 1, 2009 Accepting new patients

Locations

1643 NW 136th Ave
Ste 100
Sunrise, FL 33323
Phone (865) 500-1325

625 W Waterloo St
Canal Winchester, OH 43110
Phone (614) 355-3400

3535 Olentangy River Rd
Columbus, OH 43214
Phone (614) 566-1997

7500 Hospital Dr
Dublin, OH 43016
Phone (614) 544-8000

5868 N Hamilton Rd
New Albany, OH 43054
Phone (614) 788-9350

1010 Refugee Rd
Pickerington, OH 43147
Phone (614) 587-7601

6960 E Main St
Reynoldsburg, OH 43068
Phone (614) 788-9320

260 Polaris Pkwy
Westerville, OH 43082
Phone (614) 533-3470

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258502400000",
    "number": "1881636736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 GREEN RD",
            "address_2": "SUITE 300",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481051598",
            "telephone_number": "740-352-4127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 27TH ST",
            "city": "PORTSMOUTH",
            "state": "OH",
            "postal_code": "456622640",
            "telephone_number": "740-356-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "DAVID",
        "middle_name": "WILLIAM",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2009-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "279699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portsmouth, OH

Sources for this page

Verify at the official NPI Registry.