DR. DONALD CLINTON WILLIS (M.D.) – Obstetrics & Gynecology Physician, NPI 1902870611
Obstetrics & Gynecology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for DR. DONALD CLINTON WILLIS (M.D.)
880 Madison Ave
Memphis, TN 381033409
Phone: (901) 515-3700
Fax: (901) 515-3509
Type: Location
699, Cougar Drive, Mountain Home, Baxter County, Arkansas, 72653, United States
MOUNTAIN HOME, TN 376840699
Phone: (423) 439-7272
Fax: (423) 439-7235
Type: Mailing
North State of Franklin Road, The Y, Johnson City, Washington County, Tennessee, 37601, United States
JOHNSON CITY, TN 37604
Phone: (423) 439-7272
Fax: (423) 439-7235
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: 2018-08-03
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20100830000950 | I | Obstetrics/Gynecology | FL | TBD |
| I20180803001110 | I | Obstetrics/Gynecology | TN | 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 38103)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Family Practice | TN | |
| Hematology, Internal Medicine | TN | |
| Physical Therapist In Private Practice | FL | |
| - | TN | |
| Infectious Disease | TN | |
| - | TN | |
| Family Practice | TN | |
| Internal Medicine | TN | |
| Internal Medicine | VA | |
| Nurse Practitioner | TN |
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