DR. DEVIN WILLIS (NPI# 1295175057) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295175057 |
| Entity Type | Individual |
| Full Name | DR. DEVIN WILLIS |
| Credential | MD |
| Practice Address |
16555 Manchester Rd Ste 100 Wildwood MO 63040 |
| Mailing Address |
16555 Manchester Rd Ste 100 Wildwood MO 63040-1220 |
| Practice Telephone | 6364580646 |
| Practice Fax Number | 6364585008 |
| Mailing Telephone | 6364580646 |
| Mailing Fax Number | 6364585008 |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2019-08-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
2016023372 | MO | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 16555 Manchester Rd Ste 110, Wildwood, MO 630401220 | 6364053155 | 6364053162 |
| 4921 Parkview Pl, Ste 6a/6b/12a, Saint Louis, MO 63110 | 3147472500 | 3147472598 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184165847 | Devin Willis | Technician, Other | 41521 W 11 Mile Rd, Novi, MI 48375-1803 | 2017-03-14 |
| Street Address |
16555 MANCHESTER RD STE 100 |
| City | WILDWOOD |
| State | MO |
| Zip Code | 63040 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215392485 | Katherine Hittler | Nurse Practitioner | 16555 Manchester Rd Ste 100, Wildwood, MO 63040-1220 | 2015-12-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154959336 | Jacquelyn M Mellis | Social Worker | 2634 Hwy 109, Suite E, Wildwood, MO 63040 | 2020-04-01 |
| 1710359484 | Dierbergs Town Center Pharmacy | Pharmacy | 2460 Taylor Road, Wildwood, MO 63040 | 2015-10-21 |
| 1265748248 | Mary K Bland | Speech-Language Pathologist | 251 Plaza Dr, Wildwood, MO 63040 | 2010-08-27 |
| 1871726067 | Wildwood Internal Medicine, PC | Internal Medicine | 16759 Main Street, Suite 203, Wildwood, MO 63040 | 2009-09-03 |
| 1730274853 | Seth P Freedman | Dentist | 16920 Manchester Road, Wildwood, MO 63040 | 2006-10-04 |
| 1619332608 | Tonnya Marie Taggart | Nurse Practitioner | 16555 Manchester Rd Ste 110, Wildwood, MO 63040 | 2015-12-18 |
| 1477927556 | Forefront Dermatology, S.c. | Dermatology | 16516 Manchester Rd, Wildwood, MO 63040 | 2015-11-30 |
| 1881953784 | Glennia J Chitwood | Chiropractor | 16925 Manchester Rd, Suite 1, Wildwood, MO 63040 | 2012-05-11 |
| 1649363888 | Michael Paul Van Horenbeeck | Chiropractor | 16917 Manchester Rd, Wildwood, MO 63040 | 2006-10-02 |
| 1699314880 | Lauren Alison Medina | Chiropractor | 17197 New College Ave, Wildwood, MO 63040-1100 | 2020-01-05 |
| Find all providers in zip 63040 | ||||
| Taxonomy Code | 207QS0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Sports Medicine |
| A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation. |
| 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 Family Medicine, 2007. http://www.theabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871105312 | 417 Sports Medicine and Orthopedics LLC | Family Medicine | 330 W Plainview Rd Ste F, Springfield, MO 65810-2672 | 2020-08-17 |
| 1871115857 | Ben Heimos | Family Medicine | 1 S Compton Ave, Saint Louis, MO 63103-2001 | 2020-05-12 |
| 1639645070 | Bluetail Biologics LLC | Family Medicine | 17300 N Outer 40 Rd Ste 201, Chesterfield, MO 63005-1364 | 2018-10-23 |
| 1083096671 | Daniel O'loughlin | Family Medicine | 1605 Martin Springs Dr Ste 330, Rolla, MO 65401-2980 | 2015-06-19 |
| 1922377274 | Duocorp Enterprises, LLC | Family Medicine | 1525 E Republic Rd, Suite A115, Springfield, MO 65804-6527 | 2011-12-15 |
| 1689960171 | Nathan Lee Granneman | Family Medicine | 200 Corporate Lake Dr, Columbia, MO 65203-7172 | 2011-06-22 |
| 1063568640 | Christian Verry | Family Medicine | 12680 Olive Blvd Ste 300, Saint Louis, MO 63141-6322 | 2007-01-26 |
| 1922116763 | Kristin Suzanne Oliver | Family Medicine | 17300 North Outer 40 Rd Ste 201, Chesterfield, MO 63005-1364 | 2006-08-29 |
| 1942238027 | John J Dougherty | Family Medicine | 1010 Carondelet Dr Ste 220, Kansas City, MO 64114-4822 | 2006-06-29 |
| 1548867963 | Elizabeth Savika Liotta | Family Medicine | 916 Olive St, Saint Louis, MO 63101-1400 | 2020-10-08 |
| Find all providers with the same taxonomy | ||||
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| 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.