Active NPI
Luann Elizabeth Weber, PA-C
- Medical Physician Assistant
- Tyler, MN
National Provider Identifier
1285687004
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 9146
- Practice address
- 240 Willow St.
Tyler, MN 56178-0240 - Phone
- (507) 247-5921
- Fax
- (507) 247-5184
- NPI assigned
- May 19, 2006
- Last updated
- Feb 9, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 9146 | MN | Primary |
Addresses
Primary practice location
240 Willow St.
Tyler, MN 56178-0240
Mailing address
240 Willow St.
Tyler, MN 56178-0240
Phone (507) 247-5921
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 363716600 | Medicaid | MN |
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9146 | MN | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Avera Tyler | Current | Accepting new patients | |
| Avera Tyler | Current | Accepting new patients |
Locations
109 E Benton St
Lake Benton, MN 56149
Phone (507) 368-4323
Organizations & group practices 3
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": "1147996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1454976000000",
"number": "1285687004",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "240 WILLOW ST.",
"city": "TYLER",
"state": "MN",
"postal_code": "561780240",
"telephone_number": "507-247-5921",
"fax_number": "507-247-5184"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "240 WILLOW ST.",
"city": "TYLER",
"state": "MN",
"postal_code": "561780240",
"telephone_number": "507-247-5921",
"fax_number": "507-247-5184"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEBER",
"first_name": "LUANN",
"middle_name": "ELIZABETH",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-19",
"last_updated": "2016-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "MN",
"license": "9146",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "363716600",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tyler, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2016; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.