Tysen L Weber, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

M-15702 Issued in ID

Practice address

2315 8TH St
Lewiston, ID 83501-7301

Phone

(208) 746-1383

Fax

(208) 746-6348

NPI assigned

Jun 18, 2018

Last updated

Apr 15, 2025By 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 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in ID

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

Interoperability endpoints

• Direct secure messaging: tysen.weber.1@28344.direct.athenahealth.com

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.

• Catalyst Medical Group, PLLC

  • Multi-Specialty Clinic/Center
  • Lewiston, ID
  • NPI 1912458787
  Medicare reassignment NPD
• Weber Pediatrics PLLC

  • Pediatrics Physician
  • Lewiston, ID
  • NPI 1477396018
  NPD Authorized official
• St. Joseph Hospital LLC

  dba St. Joseph Regional Medical Center

  • General Acute Care Hospital
  • Lewiston, ID
  • NPI 1225090954
  NPD (past)

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

{
    "created_epoch": "1529280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744675200000",
    "number": "1730673419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2216 VINEYARD AVE",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835016352",
            "telephone_number": "208-289-0425",
            "fax_number": "208-568-9850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2315 8TH ST",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835017301",
            "telephone_number": "208-746-1383",
            "fax_number": "208-746-6348"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2216 Vineyard Ave",
            "address_purpose": "LOCATION",
            "city": "Lewiston",
            "state": "ID",
            "postal_code": "835016352",
            "country_code": "US",
            "telephone_number": "208-289-0425",
            "fax_number": "208-568-9850",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WEBER",
        "first_name": "TYSEN",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-18",
        "last_updated": "2025-04-15",
        "certification_date": "2025-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD61156866",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "ID",
            "license": "M-15702",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1730673419",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1730673419",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Donna P Watson
• Jordyn L Watts, ACNPC-AG
• Dewayne Lynn Weaver, MD
• Weber Pediatrics PLLC
• Jennifer Weber
• Betty J Weeks, LCSW
• Philip Louis Weidner II, PA-C
• Douglas Roy Wells, LCSW
• Tiffany Eileen Wells, NP-C
• Melissa A Welter, NP

• Pediatrics Physician in Lewiston, ID
• Providers in Lewiston, ID by specialty
• Pediatrics Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2025; 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.