SAMUEL M JR. WILLIS (MD) – Gastroenterology Physician, NPI 1770586588
Gastroenterology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for SAMUEL M JR. WILLIS (MD)
Rice Box, Atlanta BeltLine Eastside Trail, Atlanta, Georgia, 30308, United States of America
ATLANTA, GA 303842145
Phone: (803) 296-3502
Fax: (803) 296-7330
Type: Mailing
Laurel Street, Main Street District, Columbia, Richland County, South Carolina, 29204, United States of America
1-A
COLUMBIA, SC 292042028
Phone: (803) 799-4800
Fax: (803) 256-0397
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2010-02-12
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20100212000573 | I | Gastroenterology | SC | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 30384)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| GASTROENTEROLOGY | SC | 45378 | Diagnostic examination of large bowel using an endoscope | 29 | 28 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| - | SC | |
| - | GA | |
| Internal Medicine | NC | |
| Physician Assistant | SC | |
| - | SC | |
| H O S P I T A L I S T | GA | |
| Vascular Surgery | FL | |
| - | GA | |
| Interventional Cardiology, Internal Medicine | SC | |
| Orthopedic Surgery | SC |
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