Willard Randolph Vannostrand III, M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

7028 Issued in AZ

Practice address

1260 S Campbell Ave BLDG 2
Green Valley, AZ 85614-0502

Phone

(520) 407-5400

Fax

(520) 407-5990

NPI assigned

Oct 13, 2009

Last updated

Aug 23, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

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 1

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Benson Hospital Corporation

  • Critical Access Hospital
  • Benson, AZ
  • NPI 1336118322
  Medicare reassignment NPD
• Bisbee Hospital Association

  • Critical Access Hospital
  • Bisbee, AZ
  • NPI 1518968767
  Medicare reassignment NPD
• Navajo Health Foundation-Sage Memorial Hospital, Inc.

  dba Sage Memorial Physicians

  • Rural Acute Care Hospital
  • Ganado, AZ
  • NPI 1477735777
  Medicare reassignment NPD
• Nes Arizona Inc

  • Emergency Medicine Physician
  • Benson, AZ
  • NPI 1205217700
  Medicare reassignment NPD
• Benson Hospital Corporation

  • Rural Health Clinic/Center
  • Vail, AZ
  • NPI 1457924920
  NPD
• Bisbee Hospital Association

  dba Copper Queen Community Hospital Hereford RHC

  • Rural Health Clinic/Center
  • Hereford, AZ
  • NPI 1245986975
  NPD
• Bisbee Hospital Association

  dba Copper Queen Medical Associates

  • Point of Service
  • Bisbee, AZ
  • NPI 1508137209
  NPD
• Navajo Health Foundation-Sage Memorial Hospital Inc

  dba Sage Memorial Hospital

  • Critical Access Hospital Clinic/Center
  • Ganado, AZ
  • NPI 1518957398
  NPD
• Nes Arizona Inc

  • Emergency Medicine Physician
  • Fort Mohave, AZ
  • NPI 1285163121
  NPD
• Stronghold Emergency Physicians

  • Emergency Medicine Physician
  • Willcox, AZ
  • NPI 1306895909
  NPD (past)

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

{
    "created_epoch": "1255392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661212800000",
    "number": "1922333772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1260 S CAMPBELL AVE BLDG 2",
            "city": "GREEN VALLEY",
            "state": "AZ",
            "postal_code": "856140502",
            "telephone_number": "520-407-5600",
            "fax_number": "520-407-5990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1260 S CAMPBELL AVE BLDG 2",
            "city": "GREEN VALLEY",
            "state": "AZ",
            "postal_code": "856140502",
            "telephone_number": "520-407-5400",
            "fax_number": "520-407-5990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANNOSTRAND",
        "first_name": "WILLARD",
        "middle_name": "RANDOLPH",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-10-13",
        "last_updated": "2022-08-23",
        "certification_date": "2022-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "AZ",
            "license": "7028",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE BILLING NO.",
            "identifier": "01WCFBXA1",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• United Community Health Center-Maria Auxiliadora, Inc.
• United Community Health Center-Maria Auxiliadora, Inc.
• United Community Health Center-Maria Auxiliadora, Inc.
• United Community Health Center-Maria Auxiliadora, Inc.
• Valerie Lou Gold-Neil
• Alex R Verhoogen, MD
• Stephanie Beth Vidoni-Hartung, DDS
• Vista Eye Care, PLC
• Hannah Morse Vogan-Darezzo
• Vontsinger Senior Services, LLC (Home Instead Senior Care)

• General Practice Physician in Green Valley, AZ
• Providers in Green Valley, AZ by specialty
• General Practice Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2022; 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.