Mallory Beth Weber, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085006013 Issued in IL

Practice address

1725 W Harrison St
Suite 809
Chicago, IL 60612-3841

Phone

(312) 942-5904

Fax

(312) 942-3192

NPI assigned

Nov 10, 2016

Last updated

Nov 10, 2016By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Miss Mallory Beth Adams Former name

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mweber131159@direct.rush.rush-health.com

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.

• Rush University Medical Group

  dba Rush University Internists

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1093819542
  Medicare reassignment NPD

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

{
    "created_epoch": "1478736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478736000000",
    "number": "1295277077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 OVALTINE CT",
            "address_2": "APT 309",
            "city": "VILLA PARK",
            "state": "IL",
            "postal_code": "601815606",
            "telephone_number": "217-556-7274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1725 W HARRISON ST",
            "address_2": "SUITE 809",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123841",
            "telephone_number": "312-942-5904",
            "fax_number": "312-942-3192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEBER",
        "first_name": "MALLORY",
        "middle_name": "BETH",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-11-10",
        "last_updated": "2016-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085006013",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MALLORY",
            "last_name": "ADAMS",
            "middle_name": "BETH",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kimberly Marie Weber, LCPC
• Laura Weber, M.D.
• Leo Simon Weber, RPH
• Lisa E. Weber, M.S., CCC-SLP
• Lisa M Weber, AU.D.
• Nicholas Hjort Weber, D.O.
• Robin Weber, P.T.A.
• Stephen Weber
• Sydney Frances Weber, MA, LPC
• Webster Dental Care Edison Park, LTD

• Physician Assistant in Chicago, IL
• Providers in Chicago, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 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.

Verify at the official NPI Registry.