Jerry Duane Weber, LISW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

I0008237 Issued in OH

Practice address

1520 California Ave
Louisville, OH 44641

Phone

(330) 581-3681

Fax

(330) 875-1451

NPI assigned

Oct 17, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Lifecare Family Health and Dental Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Canton, OH
  • NPI 1013964923
  Medicare reassignment NPD

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

{
    "created_epoch": "1192579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1226275200000",
    "number": "1710176516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 243",
            "address_2": "1520 CALIFORNIA AVE",
            "city": "LOUISVILLE",
            "state": "OH",
            "postal_code": "44641",
            "telephone_number": "330-581-3681",
            "fax_number": "330-875-1451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 CALIFORNIA AVE",
            "city": "LOUISVILLE",
            "state": "OH",
            "postal_code": "44641",
            "telephone_number": "330-581-3681",
            "fax_number": "330-875-1451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEBER",
        "first_name": "JERRY",
        "middle_name": "DUANE",
        "name_prefix": "Mr.",
        "credential": "LISW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-17",
        "last_updated": "2008-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "OH",
            "license": "I0008237",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "I0008237",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiffany A. Wakefield
• Lorrenna Walczak
• Jeremy S Wanzer, DDS
• Amy Ward
• Jami Warner
• Dylan James Weir
• Wesley A Weisel
• Patricia Welden
• Patrick J Welden
• Lindsay West, LPCC

• Social Worker in Louisville, OH
• Providers in Louisville, OH by specialty
• Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2008; 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.