Individual provider Active NPI

Alan B. Weiner, MD

  • Family Medicine Physician
  • Cherry Hill, NJ
National Provider Identifier
1760456057
Registry record updated Feb 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
73864 Issued in MA
Practice address
401 Kings Hwy S
Cherry Hill, NJ 08034-2500
Phone
(856) 475-6166
NPI assigned
Feb 14, 2006
Last updated
Feb 28, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 73864 MA Primary
Addiction Medicine (Family Medicine) Physician 207QA0401X 25MA11214200 NJ

Addresses

Primary practice location

401 Kings Hwy S
Cherry Hill, NJ 08034-2500

Mailing address

474 Grove St
Worcester, MA 01605-1214
Phone (508) 403-7877

Other identifiers 17

IdentifierTypeStateIssuer
04-3194547OtherMAGREAT-WEST
04-3194547OtherMANORTHEAST HEALTH DIRECT
04-3194547OtherMAPRIVATE HEALTHCARE SYSTEM
2358647OtherMAAETNA
04-3194547OtherMANORTH AMERICAN PREFERRED
71794OtherMAHARVARD PILGRIM
04-3194547OtherMANORTHEAST HEALTHCARE ALLI
J11185OtherMABCBSMA
000000007921OtherMABMC
04-3194547OtherMAPLAN VISTA
1024160OtherMACIGNA
073864OtherMATUFTS
04-3194547OtherMACONSOLIDATED
04-3194547OtherMAUNICARE/GIC
3077225MedicaidMA
20409OtherMAHEALTH NEW ENGLAND
738641OtherMACONNECTICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, NC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20090304000260 MA Practitioner - Family PracticePractitioner - General Practice 0042376790
I20211116002436 NC Practitioner - Family Practice 0042376790 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25MA11214200NJMDAddiction Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Eleanor Health Professional NC, PLLC Addiction Medicine CurrentSince Oct 21, 2021 Accepting new patients

Locations

2402 S Miami Blvd
Ste 101
Durham, NC 27703
Phone (919) 765-8730

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1139875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646006400000",
    "number": "1760456057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "474 GROVE ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016051214",
            "telephone_number": "508-403-7877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 KINGS HWY S",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "080342500",
            "telephone_number": "856-475-6166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEINER",
        "first_name": "ALAN",
        "middle_name": "B.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-14",
        "last_updated": "2022-02-28",
        "certification_date": "2022-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "73864",
            "primary": true
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "NJ",
            "license": "25MA11214200",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GREAT-WEST",
            "identifier": "04-3194547",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORTHEAST HEALTH DIRECT",
            "identifier": "04-3194547",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIVATE HEALTHCARE SYSTEM",
            "identifier": "04-3194547",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2358647",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORTH AMERICAN PREFERRED",
            "identifier": "04-3194547",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM",
            "identifier": "71794",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORTHEAST HEALTHCARE ALLI",
            "identifier": "04-3194547",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSMA",
            "identifier": "J11185",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BMC",
            "identifier": "000000007921",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PLAN VISTA",
            "identifier": "04-3194547",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "1024160",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "073864",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONSOLIDATED",
            "identifier": "04-3194547",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNICARE/GIC",
            "identifier": "04-3194547",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3077225",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NEW ENGLAND",
            "identifier": "20409",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONNECTICARE",
            "identifier": "738641",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cherry Hill, NJ

Sources for this page

Verify at the official NPI Registry.