Individual provider Active NPI

Paul Gerald Weaver, DO

  • Family Medicine Physician
  • Salem, OR
National Provider Identifier
1053311191
Registry record updated Apr 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
D016350 Issued in OR
Practice address
1275 Wallace Rd NW
Salem, OR 97304-3007
Phone
(503) 371-3232
Fax
(503) 375-2398
NPI assigned
Jul 29, 2005
Last updated
Apr 28, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X D016350 OR Primary

Addresses

Primary practice location

1275 Wallace Rd NW
Salem, OR 97304-3007

Mailing address

1275 Wallace Rd NW
Salem, OR 97304-3007
Phone (503) 371-3232

Other identifiers 1

IdentifierTypeStateIssuer
288192MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110706000431 OR Practitioner - Family Practice 2163472234 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
College of Osteo Med of the Pacific at Pomona, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
West Salem Family Practice Associates LLCGroup PAC ID 7113911504, 6 clinicians

Practice addresses (Care Compare)

1275 Wallace Rd NW
Salem, OR 97304-3007
Phone (503) 371-3232

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
D016350ORMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
West Salem Family Practice Associates LLC Family Medicine CurrentSince Jul 1, 2001 Accepting new patients

Locations

1275 Wallace Rd NW
Salem, OR 97304
Phone (503) 371-0145

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: paul.weaver.wsfpa@direct.wvp.nextgenshare.com

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1122595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461801600000",
    "number": "1053311191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1275 WALLACE RD NW",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973043007",
            "telephone_number": "503-371-3232",
            "fax_number": "503-375-2398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1275 WALLACE RD NW",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973043007",
            "telephone_number": "503-371-3232",
            "fax_number": "503-375-2398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEAVER",
        "first_name": "PAUL",
        "middle_name": "GERALD",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-29",
        "last_updated": "2016-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "D016350",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "288192",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

Verify at the official NPI Registry.