Individual provider Active NPI

Patrick D Weaver, PT

  • Physical Therapist
  • Jacksonville, FL
National Provider Identifier
1124137625
Registry record updated Mar 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
2627 Riverside Ave
Suite 300
Jacksonville, FL 32204-4712
Phone
(904) 634-0640
Fax
(904) 634-0203
NPI assigned
Aug 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

2627 Riverside Ave
Suite 300
Jacksonville, FL 32204-4712

Mailing address

6500 Bowden Rd
Suite 103
Jacksonville, FL 32216-8070
Phone (904) 634-0640

Other identifiers 1

IdentifierTypeStateIssuer
PT22466OtherFLLICENSE #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131223000467 FL Practitioner - Physical Therapist in Private Practice 2264669159 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southeast Orthopedic Specialists LLCGroup PAC ID 1456246974, 144 clinicians

Practice addresses (Care Compare)

2627 Riverside Ave
FL 3
Jacksonville, FL 32204-4717
Phone (904) 634-0640

Merit-based Incentive Payment System (MIPS)

Final score
90.75 of 100Reported as group
Quality
88.19
Promoting interoperability
100
Improvement activities
40
Cost
80.96

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Orthopedic Specialists, LLC CurrentSince Nov 9, 2013 Accepting new patients
Southeast Orthopedic Specialists, LLC CurrentSince Nov 9, 2013 Accepting new patients

Locations

6500 Bowden Rd
Ste 103
Jacksonville, FL 32216

2627 Riverside Ave
Fl 3
Jacksonville, FL 32204
Phone 9046340640 ext. 1014

2627 Riverside Ave
Ste 300
Jacksonville, FL 32204
Phone (904) 634-0460

10475 Centurion Pkwy N
Ste 220
Jacksonville, FL 32256
Phone 9046340640 ext. 1014

232 Ponte Vedra Park Dr
Ponte Vedra Beach, FL 32082
Phone (904) 285-7546

Interoperability endpoints

  • Direct secure messaging: patrick.weaver.1@22724.direct.athenahealth.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427241600000",
    "number": "1124137625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6500 BOWDEN RD",
            "address_2": "SUITE 103",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322168070",
            "telephone_number": "904-634-0640",
            "fax_number": "904-634-0203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2627 RIVERSIDE AVE",
            "address_2": "SUITE 300",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044712",
            "telephone_number": "904-634-0640",
            "fax_number": "904-634-0203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEAVER",
        "first_name": "PATRICK",
        "middle_name": "D",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2015-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE #",
            "identifier": "PT22466",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.