Adam Wallace Weber, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

52905 Issued in MN

Practice address

916 Saint Peter Ave
#120
Delano, MN 55328-2813

Phone

(763) 230-2780

Fax

(763) 972-2230

NPI assigned

Aug 27, 2007

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 MN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• New Kingdom Pediatrics LLC

  • Clinic/Center
  • Eden Prairie, MN
  • NPI 1760816045
  NPD (past)

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

{
    "created_epoch": "1188172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507161600000",
    "number": "1346433976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14001 RIDGEDALE DR STE 100",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553051781",
            "telephone_number": "952-473-0211",
            "fax_number": "952-473-7908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "916 SAINT PETER AVE",
            "address_2": "#120",
            "city": "DELANO",
            "state": "MN",
            "postal_code": "553282813",
            "telephone_number": "763-230-2780",
            "fax_number": "763-972-2230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEBER",
        "first_name": "ADAM",
        "middle_name": "WALLACE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-27",
        "last_updated": "2017-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "52905",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Total Living Commitment, Inc.
• David Scott Trcka, PA-C
• Connor Turner, PHARMD
• Ellen C Vander Heyden, DDS
• Amy A Voss, MS
• Stephanie Rose Weldon, M.S. OTR/L
• David Douglas Wermager, CRNA
• Martin Barry Wiss, LICSW, LMFT
• Ashley Wood
• David Yanez, M.D.

• Pediatrics Physician in Delano, MN
• Providers in Delano, MN by specialty
• Pediatrics Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2017; 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.