NPIMap

Individual provider Active NPI

Adam Weller, M.D.

  • Diagnostic Radiology Physician
  • McCall, ID
National Provider Identifier
1568634855
Registry record updated Feb 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
M-12492 Issued in ID
Practice address
1000 State St
McCall, ID 83638-3704
Phone
(208) 634-2221
Fax
(208) 634-7112
NPI assigned
Mar 27, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X M-12492 ID Primary

Addresses

Primary practice location

1000 State St
McCall, ID 83638-3704

Mailing address

190 E Bannock St
Boise, ID 83712-6241
Phone (208) 634-2221

Other identifiers 1

IdentifierTypeStateIssuer
1568634855MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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
I20140916000393 ID Practitioner - Diagnostic RadiologyPractitioner - Interventional Radiology 2567603020 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Nevada School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Lukes Clinic - McCall LLCGroup PAC ID 7618127994, 44 clinicians

Practice addresses (Care Compare)

1000 State St
McCall, ID 83638-3704
Phone (208) 634-4061

Hospital & facility affiliations

  • St Luke'S McCall Hospital, McCall, ID, CCN 131312
  • St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006
  • Cascade Medical Center Hospital, Cascade, ID, CCN 130779
  • Saint Alphonsus Regional Medical Center Hospital, Boise, ID, CCN 130007

Merit-based Incentive Payment System (MIPS)

Final score
82.2 of 100Reported as group
Quality
85.66
Promoting interoperability
100
Improvement activities
40
Cost
55

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic - McCall LLC CurrentSince Oct 1, 2016 Accepting new patients

Locations

1000 State St
McCall, ID 83638
Phone (208) 634-2221

211 W Forest St
McCall, ID 83638
Phone (208) 467-7546

Interoperability endpoints

  • Direct secure messaging: aweller33151@direct.slhs.org

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.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1206576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455148800000",
    "number": "1568634855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241",
            "telephone_number": "208-634-2221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 STATE ST",
            "city": "MCCALL",
            "state": "ID",
            "postal_code": "836383704",
            "telephone_number": "208-634-2221",
            "fax_number": "208-634-7112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELLER",
        "first_name": "ADAM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-27",
        "last_updated": "2016-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "ID",
            "license": "M-12492",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1568634855",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in McCall, ID

Sources for this page

Verify at the official NPI Registry.