Individual provider Active NPI

Justin Weddle, PA-C

  • Physician Assistant
  • West Chester, OH
National Provider Identifier
1316491160
Registry record updated May 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.004883 Issued in OH
Practice address
7589 Tylers Place Blvd
West Chester, OH 45069-6308
Phone
(513) 755-4700
Fax
(513) 755-4717
NPI assigned
Aug 10, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 50.004883 OH Primary

Addresses

Primary practice location

7589 Tylers Place Blvd
West Chester, OH 45069-6308

Mailing address

7589 Tylers Place Blvd
West Chester, OH 45069-6308
Phone (513) 755-4700

Other identifiers 1

IdentifierTypeStateIssuer
0192451MedicaidOH

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20161216001201 OH Practitioner - Physician Assistant 8820378458 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Christ Hospital Medical Associates, LLCGroup PAC ID 0244314102, 270 clinicians

Practice addresses (Care Compare)

2123 Auburn Ave
Cincinnati, OH 45219-2906

2139 Auburn Ave
Cincinnati, OH 45219-2906
Phone (513) 585-2000

7589 Tylers Place
West Chester, OH 45069-6308
Phone (513) 755-4700

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
50.004883OHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Cleveland Clinic Foundation CurrentSince Oct 26, 2016 Accepting new patients

Locations

9500 Euclid Ave
Cleveland, OH 44195
Phone (216) 442-1270

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1470787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715040000000",
    "number": "1316491160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7589 TYLERS PLACE BLVD",
            "city": "WEST CHESTER",
            "state": "OH",
            "postal_code": "450696308",
            "telephone_number": "513-755-4700",
            "fax_number": "513-755-4717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7589 TYLERS PLACE BLVD",
            "city": "WEST CHESTER",
            "state": "OH",
            "postal_code": "450696308",
            "telephone_number": "513-755-4700",
            "fax_number": "513-755-4717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEDDLE",
        "first_name": "JUSTIN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-10",
        "last_updated": "2024-05-07",
        "certification_date": "2024-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.004883",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0192451",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Chester, OH

Sources for this page

Verify at the official NPI Registry.