Active NPI
Walter Joe Weick, M.D.
- Maternal & Fetal Medicine Physician
- Portland, OR
National Provider Identifier
1497790141
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Maternal & Fetal Medicine Physician
- License
- 16818
- Practice address
- 300 N Graham St
Suite #100
Portland, OR 97227-1683 - Phone
- (503) 413-1122
- Fax
- (503) 413-4238
- NPI assigned
- Jun 17, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Maternal & Fetal Medicine Physician | 207VM0101X | 16818 | OR | Primary |
| Maternal & Fetal Medicine Physician | 207VM0101X | MD00045734 | WA | |
| Maternal & Fetal Medicine Physician | 207VM0101X | A23031 | CA |
Addresses
Primary practice location
300 N Graham St
Suite #100
Portland, OR 97227-1683
Mailing address
300 N Graham St
Suite #100
Portland, OR 97227-1683
Phone (503) 413-1122
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 011192 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A23031 | CA | MD | Maternal & Fetal Medicine Physician |
| 16818 | OR | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Legacy Clinics LLC | Maternal & Fetal Medicine | Past | Accepting new patients |
Organizations & group practices 1
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": "1150502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202688000000",
"number": "1497790141",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 N GRAHAM ST",
"address_2": "SUITE #100",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972271683",
"telephone_number": "503-413-1122",
"fax_number": "503-413-4238"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 N GRAHAM ST",
"address_2": "SUITE #100",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972271683",
"telephone_number": "503-413-1122",
"fax_number": "503-413-4238"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEICK",
"first_name": "WALTER",
"middle_name": "JOE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-17",
"last_updated": "2008-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "207VM0101X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Maternal & Fetal Medicine",
"state": "OR",
"license": "16818",
"primary": true
},
{
"code": "207VM0101X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Maternal & Fetal Medicine",
"state": "WA",
"license": "MD00045734",
"primary": false
},
{
"code": "207VM0101X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Maternal & Fetal Medicine",
"state": "CA",
"license": "A23031",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "011192",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.