Jeffrey Thomas Weideman, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

10628 Issued in MN

Practice address

1901 Old Minnesota Ave
Saint Peter, MN 56082-1763

Phone

(507) 934-2325

NPI assigned

Aug 10, 2009

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mankato Clinic LTD 243 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jeffreyweideman@mklt.allscriptsdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mankato Clinic LTD

  • Family Medicine Physician
  • Mankato, MN
  • NPI 1629044029

  MN

  Medicare reassignment Care Compare group
• Mankato Clinic Express, LLC

  • Physician Assistant
  • Mankato, MN
  • NPI 1265626964
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1249862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594771200000",
    "number": "1013149079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1230 E MAIN ST",
            "address_2": "PO BOX 8674",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560015066",
            "telephone_number": "507-625-1811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 OLD MINNESOTA AVE",
            "city": "SAINT PETER",
            "state": "MN",
            "postal_code": "560821763",
            "telephone_number": "507-934-2325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEIDEMAN",
        "first_name": "JEFFREY",
        "middle_name": "THOMAS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-10",
        "last_updated": "2020-07-15",
        "certification_date": "2020-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MN",
            "license": "10628",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jeffreyweideman@mklt.allscriptsdirect.net",
            "affiliation": "N",
            "endpointDescription": "Mankato Clinic Direct ID, Allscripts Community",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1900 Sunrise Dr Ste 300",
            "city": "Saint Peter",
            "state": "MN",
            "country_code": "US",
            "postal_code": "560825385",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Victoria Varland, MSW, LGSW
• Nicole Lynn Veith
• Jacob Todd Veness
• Jessica Rae Waldron, MA, LMFT
• Cassandra Walters, PHARMD
• Jacey Jo Wenner
• Kimberly J Wernsing, MD
• Shane Earl Wernsing, M.D.
• Mary Elizabeth Westby, ATC
• Peter Lynn Westre, RN CNP

• All providers in Saint Peter, MN
• Medical Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.