Brockton Willey, is a medicare enrolled "Dentist" provider in East Grand Rapids, Michigan. His current practice location is
660 Croswell Ave. Se, East Grand Rapids, Michigan. You can reach out to his office (for appointments etc.) via phone at
(616) 266-2611.
Brockton Willey is licensed to practice in Illinois (license number 019030407) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1598141087.
Healthcare Provider's Profile
| Full Name | Brockton Willey |
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| Gender | Male |
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| Speciality | Dentist |
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| Location | 660 Croswell Ave. Se, East Grand Rapids, Michigan |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1598141087
- Provider Enumeration Date: 08/06/2015
- Last Update Date: 06/26/2023
Medicare PECOS Information:
- PECOS PAC ID: 2062729643
- Enrollment ID: I20150915000380
Medical Identifiers
Medical identifiers for Brockton Willey such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1598141087 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 122300000X | Dentist | 019030407 (Illinois) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Brockton Willey allows following entities to bill medicare on his behalf.
| Entity Name | Illinois Institute Of Dental Sleep Medicine Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1740518380
PECOS PAC ID: 9032242078
Enrollment ID: O20100728000545 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Brockton Willey is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Brockton Willey,
660 Croswell Ave. Se,
East Grand Rapids, MI 49506
Ph: (616) 266-2611 | Brockton Willey,
660 Croswell Ave. Se,
East Grand Rapids, MI 49506-8842
Ph: (616) 266-2611 |
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