NPIMap

Individual provider Active NPI

Roger H Weenig, M.D.

  • Dermatology Physician
  • Fridley, MN
National Provider Identifier
1134108772
Registry record updated May 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
42111 Issued in MN
Practice address
7205 University Ave NE
Fridley, MN 55432-3134
Phone
(763) 571-4000
Fax
(763) 571-4000
NPI assigned
Jan 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 42111 MN Primary

Addresses

Primary practice location

7205 University Ave NE
Fridley, MN 55432-3134

Mailing address

7205 University Ave NE
Fridley, MN 55432-3134
Phone (763) 571-4000

Other identifiers 1

IdentifierTypeStateIssuer
724483500MedicaidMN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081215000218 MN Practitioner - Dermatology 4183786809 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Temple University School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Associated Skin Care Specialists, PAGroup PAC ID 8921908047, 18 clinicians

Practice addresses (Care Compare)

119 14TH St NW
New Brighton, MN 55112-3914

500 Osborne Nerd
Suite 330
Fridley, MN 55432-2769
Phone (763) 571-4000

9600 Upland N LN
Suite 250
Maple Grove, MN 55369-4497
Phone (763) 571-4000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.79 of 100Reported as group
Quality
53.64
Promoting interoperability
100
Improvement activities
40
Cost
88.99

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Associated Skin Care Specialists, PA Dermatology CurrentSince Nov 24, 2008 Accepting new patients

Locations

11107 Ulysses St NE
Ste 200
Blaine, MN 55434
Phone (763) 571-4000

500 Osborne Rd NE
Ste 330
Fridley, MN 55432
Phone (763) 571-4000

7205 University Ave NE
Minneapolis, MN 55432
Phone (612) 298-7636

119 14th St NW
Ste 230
New Brighton, MN 55112
Phone (763) 571-4000

119 14th St NW
Ste 240
Saint Paul, MN 55112

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.

Hospital & facility affiliations 23

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1137024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1305676800000",
    "number": "1134108772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7205 UNIVERSITY AVE NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554323134",
            "telephone_number": "763-571-4000",
            "fax_number": "763-571-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7205 UNIVERSITY AVE NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554323134",
            "telephone_number": "763-571-4000",
            "fax_number": "763-571-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEENIG",
        "first_name": "ROGER",
        "middle_name": "H",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-12",
        "last_updated": "2011-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MN",
            "license": "42111",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "724483500",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fridley, MN

Sources for this page

Verify at the official NPI Registry.