NPIMap

Individual provider Active NPI

Beth A Weaver, NP

  • Family Nurse Practitioner
  • Hale, MI
National Provider Identifier
1447248703
Registry record updated Apr 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704148660 Issued in MI
Practice address
3190 Northridge Drive
Hale, MI 48739-9276
Phone
(989) 728-6000
Fax
(989) 728-6003
NPI assigned
Oct 11, 2005
Last updated
Apr 8, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704148660 MI Primary

Addresses

Primary practice location

3190 Northridge Drive
Hale, MI 48739-9276

Mailing address

PO Box 279
Hale, MI 48739-0279
Phone (989) 728-6000

Other identifiers 3

IdentifierTypeStateIssuer
105230710MedicaidMI
BW148660OtherMILICENSE
500C510200OtherBCBCS

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bethweaver@smomsjhs.allscriptsdirect.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050713000340 MI Practitioner - Nurse Practitioner 0042246837 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Progress Physical Therapy IncGroup PAC ID 5698669919, 23 clinicians
Mymichigan Medical Center TawasGroup PAC ID 9638070766, 36 clinicians

Practice addresses (Care Compare)

3076 Northridge Rd
Hale, MI 48739-9277
Phone (989) 728-0242

3190 Northridge Rd
Mymichigan Family Medicine
Hale, MI 48739-9276
Phone (989) 728-4211

5939 N Huron Rd
Mymichigan Family Medicine
Oscoda, MI 48750-9710
Phone (989) 739-1441

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mymichigan Medical Center Tawas Current Accepting new patients
Mymichigan Medical Center Tawas CurrentSince Jan 1, 2020 Accepting new patients
Northridge Family Practice LLC Current Accepting new patients
Mymichigan Medical Center Tawas CurrentSince Jan 1, 2020 Accepting new patients
Mymichigan Medical Center Tawas Past Accepting new patients
Mymichigan Medical Center Tawas Past Accepting new patients

Locations

3190 Northridge Rd
Hale, MI 48739
Phone (989) 728-4211

4000 Wellness Dr
Midland, MI 48670
Phone (844) 832-1956

5939 N Huron Rd
Oscoda, MI 48750
Phone (989) 739-1147

200 Hemlock Rd
Tawas City, MI 48763
Phone (989) 362-3411

325 E M 55
Ste B
Tawas City, MI 48763
Phone (989) 362-4626

Interoperability endpoints

  • Direct secure messaging: beth.weaver.1@11016.direct.athenahealth.com

Organizations & group practices 7

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.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617840000000",
    "number": "1447248703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 279",
            "city": "HALE",
            "state": "MI",
            "postal_code": "487390279",
            "telephone_number": "989-728-6000",
            "fax_number": "989-728-6003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3190 NORTHRIDGE DRIVE",
            "city": "HALE",
            "state": "MI",
            "postal_code": "487399276",
            "telephone_number": "989-728-6000",
            "fax_number": "989-728-6003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEAVER",
        "first_name": "BETH",
        "middle_name": "A",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-11",
        "last_updated": "2021-04-08",
        "certification_date": "2021-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704148660",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "105230710",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "BW148660",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBCS",
            "identifier": "500C510200",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bethweaver@smomsjhs.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "3190 NORTHRIDGE DRIVE",
            "city": "Hale",
            "state": "MI",
            "country_code": "US",
            "postal_code": "487399276",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hale, MI

Sources for this page

Verify at the official NPI Registry.