Individual provider Active NPI

Angelica Nicole Willis, MD

  • Internal Medicine Physician
  • Minneapolis, MN
National Provider Identifier
1932604246
Registry record updated Jul 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
71023 Issued in MN
Practice address
2450 Riverside Ave
Minneapolis, MN 55454-1450
Phone
(612) 672-6000
NPI assigned
Mar 28, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 71537-20 WI
Pediatrics Physician 208000000X 71023 MN
Pediatrics Physician 208000000X 71537-20 WI
Internal Medicine Physician 207R00000X 71023 MN Primary

Addresses

Primary practice location

2450 Riverside Ave
Minneapolis, MN 55454-1450

Mailing address

420 Delaware St. SE
Mayo Mail Code 741
Minneapolis, MN 55455-0341

Other practice location 1

8701 W Watertown Plank Rd
Milwaukee, WI 53226-3548
Phone (414) 955-4575

Other practice location 2

500 Harvard St SE
Minneapolis, MN 55455-0363
Phone (612) 273-3000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, TX2 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

Enrollment IDStateProvider typePAC IDDetails
I20220523001065 MN Practitioner - Pediatric MedicinePractitioner - Internal Medicine 0446682223 Reassigns benefits to 4 organizations
I20241101000398 TX Practitioner - Pediatric MedicinePractitioner - Internal Medicine 0446682223 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric MedicineAlso: Internal Medicine
Education
University of Michigan Medical School, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairview Health ServicesGroup PAC ID 1951213057, 677 clinicians
White Earth Indian Health CenterGroup PAC ID 1658367925, 36 clinicians

Practice addresses (Care Compare)

2450 Riverside Ave
Minneapolis, MN 55454-1450
Phone (612) 273-7838

40520 County Hwy 34
Ogema, MN 56569-9612
Phone (218) 983-4300

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.44 of 100Reported as group
Quality
82.65
Promoting interoperability
100
Improvement activities
40
Cost
77.21

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
71023MNMDInternal Medicine Physician
71537-20WIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Healtheast Medical Research Institute Internal Medicine CurrentSince Dec 1, 2022 Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Fairview Express Care Current Accepting new patients
Fairview Express Care CurrentSince Jul 1, 2022 Accepting new patients
White Earth Indian Health Center CurrentSince Sep 24, 2024 Accepting new patients
Fairview Clinics CurrentSince Jul 1, 2022 Accepting new patients
Healtheast Medical Research Institute CurrentSince Dec 1, 2022 Accepting new patients
Fairview Express Care CurrentSince Jul 1, 2022 Accepting new patients
Fairview Clinics CurrentSince Jul 1, 2022 Accepting new patients
Fairview Health Services Current Accepting new patients
Fairview Clinics Current Accepting new patients
Naytahwaush Health Center CurrentSince Sep 24, 2024 Accepting new patients
Pine Point Health Station Current Accepting new patients
Fairview Health Services CurrentSince Jul 1, 2022 Accepting new patients

Locations

14101 Fairview Dr
Ste 300
Burnsville, MN 55337
Phone (612) 273-5400

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

2471 310th Ave
#C
Mahnomen, MN 56557
Phone (218) 935-2238

14500 99th Ave N
Ste 100
Maple Grove, MN 55369
Phone (763) 898-1000

420 Delaware St SE
#741
Minneapolis, MN 55455
Phone (612) 624-8984

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

500 Harvard St SE
Minneapolis, MN 55455
Phone (612) 273-7300

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

40520 County Highway 34
#C
Ogema, MN 56569
Phone (218) 983-4300

40520 County Highway 34
Ogema, MN 56569
Phone (218) 983-4300

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

45 10th St W
Saint Paul, MN 55102
Phone (651) 232-3000

1700 University Ave W
Fl 6
Saint Paul, MN 55104
Phone (651) 232-2273

1700 University Ave W
Saint Paul, MN 55104
Phone (612) 672-6740

1575 Beam Ave
Saint Paul, MN 55109
Phone (651) 232-7000

1925 Woodwinds Dr
Woodbury, MN 55125
Phone (651) 232-0100

Interoperability endpoints

  • Direct secure messaging: awillis724819@fairview.direct-ci.com

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1522195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658880000000",
    "number": "1932604246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 DELAWARE ST. SE",
            "address_2": "MAYO MAIL CODE 741",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554550341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 RIVERSIDE AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554541450",
            "telephone_number": "612-672-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8701 W Watertown Plank Rd",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532263548",
            "country_code": "US",
            "telephone_number": "414-955-4575",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "500 Harvard St SE",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554550363",
            "country_code": "US",
            "telephone_number": "612-273-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "ANGELICA",
        "middle_name": "NICOLE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-28",
        "last_updated": "2022-07-27",
        "certification_date": "2022-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "71537-20",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "71023",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "71537-20",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "71023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.