Jacob Alan Weatherly, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A150920 Issued in CA

Practice address

6699 Alvarado Rd Ste 2200
San Diego, CA 92120-5253

Phone

(619) 265-3400

NPI assigned

Mar 20, 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 CA

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

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.

• County of Santa Clara

  • Anesthesiology Physician
  • San Jose, CA
  • NPI 1588721500

  Pediatrics

  Medicare reassignment NPD
• County of Santa Clara

  • Federally Qualified Health Center (FQHC)
  • San Jose, CA
  • NPI 1629301346
  Medicare reassignment NPD
• County of Santa Clara

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • San Jose, CA
  • NPI 1699885079
  Medicare reassignment NPD
• County of Santa Clara

  • Federally Qualified Health Center (FQHC)
  • San Jose, CA
  • NPI 1043354020
  NPD
• County of Santa Clara

  • Pharmacy
  • San Jose, CA
  • NPI 1891871919
  NPD
• Lucile Salter Packard Children'S Hospital at Stanford

  • Children's Hospital
  • Palo Alto, CA
  • NPI 1467442749
  NPD (past)
• Marilyn Kaufhold, M.D., a Medical Corporation

  • Children's Hospital
  • San Diego, CA
  • NPI 1336359389
  NPD (past)
• Rady Children'S Hospital San Diego

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • San Diego, CA
  • NPI 1851303994
  NPD (past)
• Stanford Hospital and Clinics

  • Clinical Medical Laboratory
  • Palo Alto, CA
  • NPI 1174698468
  NPD (past)

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

{
    "created_epoch": "1458432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687132800000",
    "number": "1538520457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6699 ALVARADO RD STE 2200",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921205253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6699 ALVARADO RD STE 2200",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921205253",
            "telephone_number": "619-265-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEATHERLY",
        "first_name": "JACOB",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-20",
        "last_updated": "2023-06-19",
        "certification_date": "2023-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A150920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Travis B Wease, PSYD
• Laura Weatherbee, LAC
• Allison Weatherford, ATC
• Dane Edward Weatherford, IDC
• Brett Erik Weatherington, DDS
• Jesika Lyn Weathers
• Mikayla Weathers, AMFT
• Reid Guillory Weathersby, IDC
• Benny Lee Weatherspoon III
• Amanda Weaver, NP

• Pediatrics Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2023; 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.