Jordan Weis, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

019030323 Issued in IL

Practice address

2102 W Randolph St
Vandalia, IL 62471-1973

Phone

(618) 283-4900

Fax

(618) 283-4963

NPI assigned

Jul 23, 2015

Last updated

Jul 23, 2015By the provider in NPPES

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 MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• 2102 Randolph Vandalia Professional, LLC

  • General Practice Dentistry
  • Vandalia, IL
  • NPI 1588532675
  NPD (past)
• Dynamic Dental Group, P.C.

  • General Practice Dentistry
  • Vandalia, IL
  • NPI 1811062557
  NPD (past)

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

{
    "created_epoch": "1437609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437609600000",
    "number": "1689059313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2102 W RANDOLPH ST",
            "city": "VANDALIA",
            "state": "IL",
            "postal_code": "624711973",
            "telephone_number": "618-283-4900",
            "fax_number": "618-283-4963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2102 W RANDOLPH ST",
            "city": "VANDALIA",
            "state": "IL",
            "postal_code": "624711973",
            "telephone_number": "618-283-4900",
            "fax_number": "618-283-4963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEIS",
        "first_name": "JORDAN",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-23",
        "last_updated": "2015-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019030323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Renee Waggoner
• Wal-Mart Stores, Inc (Vision Center 30-0317)
• Walmart Inc.
• WC- Vandalia Ops, LLC (Brookstone Estates of Vandalia)
• Matthew Edward Weems, FNP-C
• Shelby Well, PT, DPT
• Anthony T Wiliams, LPC
• William E Stringer DDS LTD
• Paul B Williams III, MSN, FNP, NP-C
• Wright Choice Counseling, LTD.

• Dentist in Vandalia, IL
• Providers in Vandalia, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2015; 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.