WILLIS CLINIC PLLC
NPI 1063619567
Clinic/Center - Primary Care in Osceola, AR
About Willis Clinic Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
WILLIS CLINIC PLLC (NPI 1063619567) is a healthcare organization registered as a primary care in Osceola, Arkansas and active in the NPI registry since June 2007. The organization holds a CLIA Waiver certificate valid through August 13, 2028 and lists Timothy W Willis, Coo/practice Manager, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Other Identifiers 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Willis Clinic Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Willis Clinic PLLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 04D1087968
Willis Clinic PLLC · Osceola, ARFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Willis Clinic's NPI number?
The NPI number for Willis Clinic is 1063619567. It was assigned to this organization in the NPPES registry on June 28, 2007. The provider is doing business as Willis Clinic PLLC.
Where is Willis Clinic located?
Willis Clinic is located at 616 W Lee Ave, Osceola, AR 72370. The listed phone number is (870) 563-2545.
What is Willis Clinic's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is Willis Clinic enrolled in Medicare?
Yes. Willis Clinic is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Willis Clinic?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Willis Clinic, in Family Practice and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Willis Clinic hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 04D1087968) is associated with this NPI, valid through August 13, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Willis Clinic accept?
Health plans from Ambetter Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Superior HealthPlan and Ambetter of Oklahoma and 1 other insurer list Willis Clinic as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Willis Clinic was last updated on January 20, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Willis Clinic Pllc · NPI 1063619567
Primary Care organization in Osceola, Arkansas. Organization record, active in the CMS NPPES registry since June 28, 2007.
## Identity
- **NPI:** 1063619567 (Entity type: Organization)
- **Enumerated:** June 28, 2007
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Legal business name:** Willis Clinic
- **Organization subpart:** No
- **Authorized official:** Timothy Willis, COO/PRACTICE MANAGER
## Practice location
- **Address:** 616 W LEE AVE, Osceola, AR 72370-3002
- **Phone:** (870) 563-2545 · **Fax:** (870) 563-2482
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Family Practice (1), Nurse Practitioner (1); 1 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 20, 2021
- **Other identifiers:** Medicaid 165422001 (AR)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1063619567) · Data from the CMS NPPES public registry.