Active NPI
Thomas Rice Willett, D.O.
- Family Medicine Physician
- Green Lake, WI
National Provider Identifier
1902806243
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 17659
- Practice address
- N6205 Busse Rd
Green Lake, WI 54941-8500 - Phone
- (920) 294-3444
- Fax
- (920) 294-6660
- NPI assigned
- Jul 28, 2005
- Last updated
- Dec 31, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 17659 | WI | Primary |
Addresses
Primary practice location
N6205 Busse Rd
Green Lake, WI 54941-8500
Mailing address
PO Box 429
N6250 Busse Drive
Green Lake, WI 54941-0429
Phone (920) 294-3444
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17659 | WI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jeffrey G. Bentson, M.D., PLLC | Past | Accepting new patients | |
| Green Lake Medical Clinic | Past | Accepting new patients | |
| Community Medical Center of Green Lake, LLC | Family Medicine | Past | Accepting new patients |
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Clinical Medical Laboratory
- Green Lake, WI
- NPI 1316087885
-
- Family Medicine Physician
- Green Lake, WI
- NPI 1306986716
-
dba CHN Medical Center Green Lake
- Family Medicine Physician
- Green Lake, WI
- NPI 1568622280
-
- Orthopaedic Surgery Physician
- Port Charlotte, FL
- NPI 1083850820
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1122508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1262217600000",
"number": "1902806243",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 429",
"address_2": "N6250 BUSSE DRIVE",
"city": "GREEN LAKE",
"state": "WI",
"postal_code": "549410429",
"telephone_number": "920-294-3444",
"fax_number": "920-294-6660"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "N6205 BUSSE RD",
"city": "GREEN LAKE",
"state": "WI",
"postal_code": "549418500",
"telephone_number": "920-294-3444",
"fax_number": "920-294-6660"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLETT",
"first_name": "THOMAS",
"middle_name": "RICE",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-07-28",
"last_updated": "2009-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WI",
"license": "17659",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Green Lake, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.