Jake Daniel Van Weezep

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

02006978A Issued in IN

Practice address

101 Bodin Cir
Fairfield, CA 94535-1809

Phone

(707) 423-7961

Fax

(707) 423-3501

NPI assigned

Apr 15, 2021

Sex

Male

Sole proprietor

No

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 IN

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

State licenses

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

{
    "created_epoch": "1618444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1720669393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 BODIN CIR",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945351809",
            "telephone_number": "707-423-3057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 BODIN CIR",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945351809",
            "telephone_number": "707-423-7961",
            "fax_number": "707-423-3501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN WEEZEP",
        "first_name": "JAKE",
        "middle_name": "DANIEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-15",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "IN",
            "license": "02006978A",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02006978A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Valerie Valles
• Valley Oxygen
• Value Hearing (Fairfield) LLC
• Jacquelyn Anette Van Buren, RADT
• Cynthia Louise Van Nostrand
• Britnee Vanburen
• Daniella Vance
• Amy Danielle Vanegas
• Deniece Vanfranklin
• Branwen Lee Vang

• Family Medicine Physician in Fairfield, CA
• Providers in Fairfield, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2024; 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.