JACK K JR. WILLIS (PA) – Physician Assistant, NPI 1063664183
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
8,491 PHYSICIAN ASSISTANT in TX
Provider Addresses for JACK K JR. WILLIS (PA)
4060 MEDICAL PARK DR
ODESSA, TX 797652233
Phone: (432) 582-2882
Fax: (432) 582-2884
Type: Mailing
4060 MEDICAL PARK DR # A
ODESSA, TX 797652233
Phone: (432) 582-2882
Fax: (432) 582-2884
Type: Location
407, Kent Street, Midland, Midland County, Michigan, 48642, United States
MIDLAND, TX 797015858
Phone: (432) 687-2273
Fax: (432) 687-1016
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 23 Open Payments records for all available years, with a total value of $420.
Total Amount is formed as General ($420) + Research ($0) + Ownership ($0) = $420.
Last reported payment date: 2024-10-11 • Largest payer in this snapshot: Exact Sciences Corporation ($89).
Total Amount
$420
General + Research + Ownership
Payments
23
Total payment records
General Amount
$420
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-10-11
Latest reported date
Top Companies
Largest payers in this snapshot
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: 2008-12-23
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 |
|---|---|---|---|---|
| I20081223000268 | I | Physician Assistant | TX | 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 |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 63 | 51 | $0 |
| J1100 | Injection, dexamethasone sodium phosphate, 1 mg | 62 | 11 | $0 |
| 96372 | Injection of drug or substance under skin or into muscle | 16 | 15 | $0 |
| G0446 | Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes | 13 | 13 | $0 |
| 99497 | Advance care planning, first 30 minutes | 12 | 12 | $0 |
Insurance plans in this area (ZIP 79765)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Family Practice | TX | |
| Physician Assistant | TX | |
| Physician Assistant | TX | |
| Physician Assistant | TX | |
| Nurse Practitioner | TX | |
| Physician Assistant | TX | |
| Physician Assistant | TX | |
| - | TX | |
| Physician Assistant | CT |
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