DR. JERROLD C WILLIS (MD) – Diagnostic Radiology Physician, NPI 1467407072
Diagnostic Radiology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
2,121 DIAGNOSTIC RADIOLOGY in IL
Provider Addresses for DR. JERROLD C WILLIS (MD)
MID AMERICA RADIOLOGY SC
PO BOX 66971
ST LOUIS, MO 631666971
Phone: (303) 465-0401
Fax: (303) 438-1351
Type: Mailing
PO BOX 2153 DEPT 20002
BIRMINGHAM, AL 352870001
Phone: (877) 465-0012
Fax: (303) 438-1351
Type: Mailing
1 GOOD SAMARITAN WAY
RADIOLOGY DEPT
MOUNT VERNON, IL 628642402
Phone: (618) 242-4600
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.
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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: 2004-07-09
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 |
|---|---|---|---|---|
| I20040709001419 | I | Diagnostic Radiology | IL | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 77067 | Screening mammography | 367 | 367 | $0 |
| 77063 | Screening 3d breast mammography | 366 | 366 | $0 |
| 71045 | X-ray of chest, 1 view | 243 | 229 | $0 |
| 70450 | Ct scan head or brain without contrast | 158 | 155 | $0 |
| 71250 | Ct scan of chest without contrast | 153 | 150 | $0 |
Insurance plans in this area (ZIP 63166)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| DIAGNOSTIC RADIOLOGY | IL | 71250 | CT scan chest | 25 | 20 |
| DIAGNOSTIC RADIOLOGY | IL | 74177 | CT scan of abdomen and pelvis with contrast | 76 | 67 |
| DIAGNOSTIC RADIOLOGY | IL | 78452 | Nuclear medicine study of vessels of heart using drugs or exercise multiple studies | 177 | 177 |
| DIAGNOSTIC RADIOLOGY | IL | 78815 | Nuclear medicine study with CT imaging skull base to mid-thigh | 51 | 48 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Emergency Medicine, Family Practice | IN | |
| Nurse Practitioner | IL | |
| P A T H O L O G Y | OH | |
| Interventional Radiology, Diagnostic Radiology | PA | |
| Emergency Medicine | IL | |
| Family Practice, Obstetrics/Gynecology | IN | |
| Orthopedic Surgery | WI | |
| Hospitalist, Family Practice, Family Practice | IN | |
| Emergency Medicine, Internal Medicine | MS | |
| Certified Registered Nurse Anesthetist (Crna) | IL |
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