Active NPI
Barry Craig Weaver
- Specialist
- Bloomington, IL
National Provider Identifier
1609824242
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 036078523
- Practice address
- 306 Saint Joseph Dr
Bloomington, IL 61701-3506 - Phone
- (309) 663-2354
- Fax
- (309) 662-8602
- NPI assigned
- May 5, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 036078523 | IL | Primary |
Addresses
Primary practice location
306 Saint Joseph Dr
Bloomington, IL 61701-3506
Mailing address
306 Saint Joseph Dr
Bloomington, IL 61701-3506
Phone (309) 663-2354
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036078523 | Medicaid | IL |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036078523 | IL | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gibson Community Hospital Association | 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.
-
- Critical Access Hospital
- Gibson City, IL
- NPI 1114935681
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146787200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375056000000",
"number": "1609824242",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "306 SAINT JOSEPH DR",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617013506",
"telephone_number": "309-663-2354",
"fax_number": "309-662-8602"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "306 SAINT JOSEPH DR",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617013506",
"telephone_number": "309-663-2354",
"fax_number": "309-662-8602"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEAVER",
"first_name": "BARRY",
"middle_name": "CRAIG",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-05",
"last_updated": "2013-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "IL",
"license": "036078523",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036078523",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.