Jason Willis
Internal Medicine

Address: 1101 12th Ave, Nw, Mercy Ardmore Hospital Wound Care Center, Ardmore, OK 73401
Phone: 5802206290

Jason Willis (NPI# 1679603153) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider Identifier (NPI) 1679603153
Entity Type Individual
Full Name Jason Willis
Credential MD
Gender Male
Practice Address 1101 12th Ave, Nw
Mercy Ardmore Hospital Wound Care Center
Ardmore
OK 73401
Practice Telephone 5802206290
Mailing Address Po Box 848371
Boston
MA 02284-8371
Mailing Telephone 5809209000
Mailing Fax Number 5809209159
Sole Proprietor No, this individual is not a Sole Proprietor
Enumeration Date 2007-03-06
Last Update Date 2015-10-19

Taxonomy Codes

Primary Taxonomy Classification Taxonomy Group License Number State
Yes 207R00000X Internal Medicine Allopathic & Osteopathic Physicians 29655 OK

Providers with the same name

NPI Name Taxonomy Address Enumeration
1265834402 Jason Willis Nurse Practitioner 2200 Childrens Way, Nashville, TN 37232-0005 2014-09-18
1750700316 Jason Willis Internal Medicine 1515 Holcombe Blvd, Houston, TX 77030-4009 2014-04-10
1437574084 Jason Alexander Willis Physician Assistant 472 Rankin Dr, Marion, NC 28752-6568 2014-02-19
1689942054 Jason Willis Case Manager/Care Coordinator 6701 Highway 67 Bldg 4, Benton, AR 72015-8909 2011-12-13
1205091410 Jason J Willis Podiatrist 6260 Delaware St, Beaumont, TX 77706-7602 2008-07-28
1487857983 Jason S. Willis Pathology 4770 Regent Blvd, Irving, TX 75063-2445 2007-06-11
1013948215 Jason Willis Physician Assistant 522 W Newton St, Suite 100, Greensburg, PA 15601-2820 2006-07-05

Physician Overview

NPI 1679603153
PAC ID by PECOS 8921043019
Professional Enrollment ID I20130626000621
Full Name Jason L. Willis
Organization Legal Name FAMILY HEALTH CENTER OF SOUTHERN OKLAHOMA INC
Phone Number 58037123433369
Gender M
Credential MD
Graduation Year 1997
Primary Specialty INTERNAL MEDICINE
Group Practice PAC ID 4284537457
Number of Group Practice Members 11
Accepts Medicare Assignment Y
Report Quality Measures Y

Claims Based Hospital Affiliation

Claim Control Number (CCN) Legal Business Name
370047 MERCY HOSPITAL ARDMORE, INC

Taxonomy Information

Taxonomy Code 207R00000X
Grouping Allopathic & Osteopathic Physicians
Classification Internal Medicine

Taxonomy Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source]
- Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1578906657 Mercy Hospital Ardmore, Inc Internal Medicine 1101 14th Ave Nw, Ardmore, OK 73401-1830 2013-04-09
1467780940 Elyse Gail Seltzer Internal Medicine 128 Saint Georges Rd, Ardmore, PA 19003-2506 2009-11-23
1194053702 Newman M Yeilding IIi Internal Medicine 129 Edgewood Rd, Ardmore, PA 19003-2507 2009-11-20
1306985882 Bruce Stewart Gilmore Internal Medicine 1015 S Commerce St, Ardmore, OK 73401-5018 2007-02-05
1861432940 Steven Demetrius Saris Internal Medicine 130 Valley Rd, Ardmore, PA 19003-1511 2006-06-07
1215986559 A. Wayne Troncelliti Internal Medicine 1522 Wynnewood Rd, Ardmore, PA 19003-2719 2006-05-05
1811951999 Jeffery A Rother Internal Medicine 1221 G St Nw, Ardmore, OK 73401-1812 2006-04-14
1366404105 Brian Michael Shockey Internal Medicine 2419 Chickasaw Blvd, Ardmore, OK 73401-1466 2006-04-05
1457331175 Medical Arts Clinic of Ardmore Inc Internal Medicine 921 14th Ave Nw, Ardmore, OK 73401-1837 2006-01-19
1386090066 Jody Lee Smith Internal Medicine 1011 14th Ave Nw, Ardmore, OK 73401-1828 2016-05-11
Find all providers in ARDMORE

Office Location

Street Address 1101 12TH AVE, NW
MERCY ARDMORE HOSPITAL WOUND CARE CENTER
City ARDMORE
State OK
Zip Code 73401

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1487213302 Rachel Diane Wrany Nurse Practitioner Oklahoma Heart Hospital Physicians, LLC, 731 12th Avenue Nw, Suite 202, Ardmore, OK 73401 2019-06-13
1790349991 Shirley Denise Brown Licensed Psychiatric Technician 1219 Kst N.w, 1219 Kst N.w, Ardmore, OK 73401 2019-04-24
1427512359 Billy Joe Oshields Case Manager/Care Coordinator 6862 State Hwy 199 Ardmore Oklahoma, 6862 State Hwy 199, Ardmore, OK 73401 2019-01-24
1174007595 Tawnya Dawn Peery Nurse Practitioner 1108 W. Walnut Drive, Ardmore, OK 73401 2018-09-21
1679055016 Teresa Marie Hernandez Behavior Technician 1219 K St. Nw, Ardmore, OK 73401 2018-09-01
1063991974 Sawyer Rae Shamburger Occupational Therapy Assistant 208 North Praire St, Pilot Point, TX 73401 2018-08-10
1417473521 Chelsye Bacon Peer Specialist 905 Holiday Drive, Ardmore, OK 73401 2017-08-21
1003279746 Jeni Presley Marriage & Family Therapist Outpatient Services-ardmore; 2510 Chickasaw Dr., Strong Family Development;, Ardmore, OK 73401 2016-03-31
1982080909 Alison Hill Pharmacist 1111 N. Commerce, Ardmore, OK 73401 2015-07-31
1316346547 Olivia Larae Carrell Counselor 15 Monroe Street Ne, Ardmore, OK 73401 2014-08-13
Find all providers in zip 73401

Competitor

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City ARDMORE
Zip Code 73401

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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