Shane Weideman

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LPC-6270 Issued in ID

Practice address

2007 E Quail Run Rd
Emmett, ID 83617-5059

Phone

(208) 365-5445

NPI assigned

Sep 19, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Emmett Counseling and Psychiatric Services LLC 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Emmett Counseling and Psychiatric Services, LLC

  • Community/Behavioral Health Agency
  • Emmett, ID
  • NPI 1992007249

  ID

  Medicare reassignment Care Compare group NPD
• Emmett Counseling and Psychiatric Services, LLC

  • Community/Behavioral Health Agency
  • Payette, ID
  • NPI 1972805224
  NPD

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

{
    "created_epoch": "1474243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474243200000",
    "number": "1336697366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2305 VALLEY VIEW DR",
            "city": "WEISER",
            "state": "ID",
            "postal_code": "836721245",
            "telephone_number": "208-540-0226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2007 E QUAIL RUN RD",
            "city": "EMMETT",
            "state": "ID",
            "postal_code": "836175059",
            "telephone_number": "208-365-5445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEIDEMAN",
        "first_name": "SHANE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-09-19",
        "last_updated": "2016-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "ID",
            "license": "LPC-6270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emme Warnken
• Warren Willis DMD P.C.
• Laura Ann Watson, LCSW
• Lisa Watson, LMSW, LCSW
• Ty C Weber, FNP-C
• Evan White
• Sara Marie Williams
• Warren Richard Willis, D.M.D
• Robin Wood Reed, LCSW
• Thomas Whalen Woodward, O.D.

• All providers in Emmett, ID
• Mental Health Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 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.
• 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.