Everett Lawrence Weiss, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036117699 Issued in IL

Practice address

820 E Terra Cotta Ave
Suite 226
Crystal Lake, IL 60014-3649

Phone

(815) 455-2100

Fax

(425) 988-1002

NPI assigned

Apr 6, 2007

Sex

Male

Sole proprietor

Yes

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 NY

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.

• The Unity Hospital of Rochester

  • General Acute Care Hospital
  • Rochester, NY
  • NPI 1760421713
  Medicare reassignment NPD
• The Unity Hospital of Rochester

  • General Acute Care Hospital
  • Rochester, NY
  • NPI 1457395766
  NPD
• Rochester General Hospital

  • General Acute Care Hospital
  • Rochester, NY
  • NPI 1255360517
  NPD (past)

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

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335139200000",
    "number": "1700909728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 W FAIRVIEW CIR",
            "city": "PALATINE",
            "state": "IL",
            "postal_code": "600677901",
            "telephone_number": "847-496-7934",
            "fax_number": "425-988-1002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 E TERRA COTTA AVE",
            "address_2": "SUITE 226",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600143649",
            "telephone_number": "815-455-2100",
            "fax_number": "425-988-1002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEISS",
        "first_name": "EVERETT",
        "middle_name": "LAWRENCE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-06",
        "last_updated": "2012-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036117699",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036117699",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Leslie Dawn Weckerlin, RPH
• Kelsey R Wedwick, ATC
• Kristin Elise Weeks, LCSW
• Pamela Weeks, RN;LCSW
• Sharon Ann Weise, P.T.
• David Welch, LCPC
• Well-Rooted Pediatrics LLC
• Wellness Institute of Illinois, LTD
• Wellness Institute of Illinois, LTD.
• Breanne Nichole Welty

• Pediatrics Physician in Crystal Lake, IL
• Providers in Crystal Lake, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2012; 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.