Individual provider Active NPI

Ronald D Weissenberg, D.O.

  • Surgery Physician
  • Warsaw, NY
National Provider Identifier
1336249911
Registry record updated Dec 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
277752 Issued in NY
Practice address
400 N Main St
Warsaw, NY 14569-1025
Phone
(585) 786-1249
Fax
(585) 861-6200
NPI assigned
Sep 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 277752 NY Primary

Addresses

Primary practice location

400 N Main St
Warsaw, NY 14569-1025

Mailing address

400 N Main St
Warsaw, NY 14569-1025
Phone (585) 786-1249

Other identifiers 2

IdentifierTypeStateIssuer
04053687MedicaidNY
J400257354OtherNYMEDICARE PTAN (INDIVIDUAL)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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 1

Enrollment IDStateProvider typePAC IDDetails
I20151117002486 NY Practitioner - General Surgery 3870697188 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
98.56 of 100Reported as apm
Quality
87.76
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4512AZMDDentist
277752NYMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Canton-Potsdam Hospital CurrentSince Nov 1, 2022 Accepting new patients
Canton-Potsdam Hospital CurrentSince Nov 1, 2022 Accepting new patients
Wyoming County Surgery Current Accepting new patients
Canton-Potsdam Medical Practice PLLC CurrentSince Nov 1, 2022 Accepting new patients
Wyoming County Surgery Current Accepting new patients
Massena Hospital Inc CurrentSince Jun 1, 2024 Accepting new patients
Wyoming County CurrentSince Dec 4, 2014 Accepting new patients
Massena Hospital, Inc CurrentSince Jun 1, 2024 Accepting new patients
Wyoming County Surgery CurrentSince Dec 4, 2014 Accepting new patients
Canton Potsdam Hospital PastSince Nov 1, 2022 Accepting new patients

Locations

80 E Main St
Canton, NY 13617
Phone (315) 261-6034

77 W Barney St
Gouverneur, NY 13642
Phone (315) 287-1000

1 Hospital Dr
Massena, NY 13662
Phone (315) 764-1711

201 Market St
Ste E
Potsdam, NY 13676
Phone (315) 274-9102

50 Leroy St
Potsdam, NY 13676
Phone (315) 261-6034

25 Cottage St
Potsdam, NY 13676
Phone (315) 261-6034

400 N Main St
Warsaw, NY 14569
Phone (585) 786-1555

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1159056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608249600000",
    "number": "1336249911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 N MAIN ST",
            "city": "WARSAW",
            "state": "NY",
            "postal_code": "145691025",
            "telephone_number": "585-786-1249",
            "fax_number": "866-504-1133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N MAIN ST",
            "city": "WARSAW",
            "state": "NY",
            "postal_code": "145691025",
            "telephone_number": "585-786-1249",
            "fax_number": "585-861-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEISSENBERG",
        "first_name": "RONALD",
        "middle_name": "D",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-24",
        "last_updated": "2020-12-18",
        "certification_date": "2020-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NY",
            "license": "277752",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04053687",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN (INDIVIDUAL)",
            "identifier": "J400257354",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Warsaw, NY

Sources for this page

Verify at the official NPI Registry.