Theodore C Weatherwax, MD

Primary specialty

Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X

License

291350 Issued in MA

Practice address

55 Fruit St
Boston, MA 02114-2621

Phone

(617) 726-3557

NPI assigned

Jul 2, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MA, TX, WA3 enrollments

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 3

Specialty

Emergency Medicine

Education

University of New Mexico School of Medicine, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sunnyside Emergency Group a Professional LLCGroup PAC ID 0941424451, 17 clinicians

Rosebud Indian Health ServiceGroup PAC ID 6901704055, 76 clinicians

Massachusetts General Physicians Organization IncGroup PAC ID 2466365820, 3,494 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Astria Sunnyside Hospital Hospital, Sunnyside, WA, CCN 501330
• PHS Indian Hospital at Rosebud Hospital, Rosebud, SD, CCN 430084
• Massachusetts General Hospital Hospital, Boston, MA, CCN 220071
• Cascade Medical Center Hospital, Leavenworth, WA, CCN 501313

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Massachusetts General Physicians Organization Inc

  • Dermatology Physician
  • Boston, MA
  • NPI 1801874573
  Medicare reassignment Care Compare group NPD
• Rosebud Indian Health Service

  • General Acute Care Hospital
  • Rosebud, SD
  • NPI 1194757369

  TX

  Medicare reassignment Care Compare group NPD
• Sunnyside Emergency Group a Professional LLC

  • Emergency Medicine Physician
  • Sunnyside, WA
  • NPI 1033529367
  Medicare reassignment Care Compare group NPD
• The General Hospital Corporation

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1023049236
  Medicare reassignment NPD
• DHHS IHS Phoenix Area

  • Critical Access Hospital
  • Polacca, AZ
  • NPI 1356628028

  Family Medicine, TX

  Medicare reassignment NPD
• US Health Dept of Health & Human Services

  • Rural Health Clinic/Center
  • Poplar, MT
  • NPI 1972694602

  TX

  Medicare reassignment
• Rosebud Indian Health Service

  • Ambulatory Surgical Clinic/Center
  • Rosebud, SD
  • NPI 1790955128
  NPD
• U S Health Dept of Health & Human Services

  • Critical Access Hospital
  • Lodge Grass, MT
  • NPI 1750410395
  NPD
• U S Health Dept of Health & Human Services

  • General Acute Care Hospital
  • Browning, MT
  • NPI 1861409955
  NPD

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

• Rosebud Indian Health Service

  • General Acute Care Hospital
  • Rosebud, SD
  • NPI 1427419282
  Care Compare affiliation Name & address match
• The General Hospital Corporation

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1023049236
  Care Compare affiliation
• Chelan County Public Hospital District No. 1

  • Rural Acute Care Hospital
  • Leavenworth, WA
  • NPI 1962406389
  Care Compare affiliation
• Sunnyside Community Hospital Association

  • Critical Access Hospital
  • Sunnyside, WA
  • NPI 1225033814
  Care Compare affiliation

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

{
    "created_epoch": "1562025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669161600000",
    "number": "1144882879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2209 E 32ND ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984044922",
            "telephone_number": "253-593-0232",
            "fax_number": "253-593-3311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 FRUIT ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142621",
            "telephone_number": "617-726-3557"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2209 E 32nd St",
            "address_purpose": "LOCATION",
            "city": "Tacoma",
            "state": "WA",
            "postal_code": "984044922",
            "country_code": "US",
            "telephone_number": "253-593-0232",
            "fax_number": "253-593-3311",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WEATHERWAX",
        "first_name": "THEODORE",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-02",
        "last_updated": "2022-11-23",
        "certification_date": "2022-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MDRE.ML.60958797",
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "MA",
            "license": "291350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert David Weatherford, MD
• Robin P Weatherill, PHD
• Madison Erin Weatherly, MS
• Amanda Weathers, NP
• Kate Emma Weathersbee, PA-C
• Benjamin Weaver
• Benjamin Weaver, MD
• Dana Sterling Weaver, PA-C
• Lindsay Weaver
• Markee Weaver

• Addiction Medicine (Family Medicine) Physician in Boston, MA
• Providers in Boston, MA by specialty
• Addiction Medicine (Family Medicine) Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2022; 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.