Jerry W Weiner, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

G559960 Issued in CA

Practice address

1206 E North St
Manteca, CA 95336

Phone

(209) 823-7874

Fax

(209) 823-1709

NPI assigned

Aug 16, 2006

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

Other identifiers 1

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

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Sutter Tracy Community Hospital

  • General Acute Care Hospital
  • Tracy, CA
  • NPI 1043291164
  NPD (past)

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689787442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1206 E NORTH ST",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "95336",
            "telephone_number": "209-823-7874",
            "fax_number": "209-823-1709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1206 E NORTH ST",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "95336",
            "telephone_number": "209-823-7874",
            "fax_number": "209-823-1709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEINER",
        "first_name": "JERRY",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "G559960",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G559960",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walmart Stores, Inc.
• Stephani Rae Walton, RN, BSN, MS, CDE
• Qihua Wang
• Annie Gene Banks Wardle, MSW
• Dave B Watts, RPH
• Weldwoods Residential Care Home LLC
• Maycie Eliana Werner
• Douglas Bryan Wesson, ACA
• Wesson, Inc.
• West Coast Medical Labs Inc

• Surgery Physician in Manteca, CA
• Providers in Manteca, CA by specialty
• Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.