Individual provider Active NPI

Andrew Weber, PA-C

  • Physician Assistant
  • Kirksville, MO
National Provider Identifier
1760939474
Registry record updated Oct 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2016032740 Issued in MO
Practice address
1611 S Baltimore St
Kirksville, MO 63501-4518
Phone
(660) 665-7575
NPI assigned
Sep 10, 2016
Last updated
Oct 17, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2016032740 MO Primary

Addresses

Primary practice location

1611 S Baltimore St
Kirksville, MO 63501-4518

Mailing address

1611 S Baltimore St
Kirksville, MO 63501-4536

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170728003029 MO Practitioner - Physician Assistant 8527339241 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Univ of Missouri-Kansas City School of Dentistry, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

624 W Lockling St
Brookfield, MO 64628-2003
Phone (660) 268-4006

6500 Hospital Dr
Hannibal, MO 63401-6890
Phone (573) 248-1300

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2016032740MOMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Hannibal Regional Healthcare System, Inc CurrentSince Jul 1, 2017 Accepting new patients

Locations

6500 Hospital Dr
Hannibal, MO 63401
Phone (573) 629-3400

1611 S Baltimore St
Kirksville, MO 63501
Phone (660) 372-9595

1206 N Missouri St
Ste C
Macon, MO 63552
Phone (660) 395-7575

Interoperability endpoints

  • Direct secure messaging: andrew.weber.p1@direct.cfmkv.nextgenshare.com

Organizations & group practices 2

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1473465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539734400000",
    "number": "1760939474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1611 S BALTIMORE ST",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635014536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 S BALTIMORE ST",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635014518",
            "telephone_number": "660-665-7575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEBER",
        "first_name": "ANDREW",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-09-10",
        "last_updated": "2018-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2016032740",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kirksville, MO

Sources for this page

Verify at the official NPI Registry.