DR. RUDOLPH WILLIS MD
NPI 1104887819
Family Medicine in Irvington, NJ
About Dr. Rudolph Willis Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. RUDOLPH WILLIS MD (NPI 1104887819) is an individual family medicine provider in Irvington, New Jersey, licensed in New Jersey (25MA04275000) and active in the NPI registry since March 2006. He is enrolled in Medicare PECOS, is affiliated with Englewood Hospital And Medical Center, and is a graduate of Rutgers R W Johnson Medical School (cam/new Bruns/pisc) (1982).
NPPES Registry Identity
Specialties & Licenses 2
Other Identifiers 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Dr. Rudolph Willis Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Areas of Expertise CMS Part B claims 3
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Hospital Affiliations CMS Care Compare
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Englewood Hospital And Medical Center
Acute Care Hospitals · Englewood, NJPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 07111 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Medicare Quality Performance CMS QPP · MIPS
Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.
Other Providers at the Same Location NPPES 5
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
IRVINGTON, NJ 07111
Frequently 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 Rudolph Willis's NPI number?
The NPI number for Rudolph Willis is 1104887819. It was assigned to this individual provider in the NPPES registry on March 31, 2006.
Where is Rudolph Willis located?
Rudolph Willis practices at 12 Krotik Pl Irvington Emergent Care And Rehabilitation Center Inc., Irvington, NJ 07111. The listed phone number is (973) 373-3000.
What is Rudolph Willis's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Rudolph Willis enrolled in Medicare?
Yes. Rudolph Willis is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
What insurance does Rudolph Willis accept?
Health plans from Ambetter Health and Ambetter Health of Delaware list Rudolph Willis 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.
Is Rudolph Willis affiliated with any hospitals?
According to CMS data, Rudolph Willis is affiliated with Englewood Hospital And Medical Center.
When was this NPI record last updated?
The NPPES record for Rudolph Willis was last updated on March 10, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months 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.
# Dr. Rudolph Willis, MD · NPI 1104887819
Family Medicine physician in Irvington, New Jersey. Individual provider, active in the CMS NPPES registry since March 31, 2006.
## Identity
- **NPI:** 1104887819 (Entity type: Individual)
- **Enumerated:** March 31, 2006
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **State license:** 25MA04275000 (New Jersey)
- **Sole proprietor:** No
## Practice location
- **Address:** 12 KROTIK PL, IRVINGTON EMERGENT CARE AND REHABILITATION CENTER INC., Irvington, NJ 07111-1708
- **Phone:** (973) 373-3000
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Medical school:** Rutgers R W Johnson Medical School, class of 1982
## Record status
- **NPPES last updated:** March 10, 2026
- **Other identifiers:** Medicaid 0887307 (NJ)
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Source: [NPI Profile](https://npiprofile.com/npi/1104887819) · Data from the CMS NPPES public registry.