Individual provider Active NPI

Michael Eric Weiss, MD

  • Pediatric Emergency Medicine (Pediatrics) Physician
  • Hollywood, FL
National Provider Identifier
1780612028
Registry record updated Mar 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Emergency Medicine (Pediatrics) PhysicianTaxonomy code 2080P0204X
License
ME75622 Issued in FL
Practice address
3501 Johnson Streeet
Hollywood, FL 33021
Phone
(954) 987-2000
Fax
(954) 985-3453
NPI assigned
Jun 28, 2006
Last updated
Mar 29, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X ME75622 FL
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X ME75622 FL Primary

Addresses

Primary practice location

3501 Johnson Streeet
Hollywood, FL 33021

Mailing address

PO Box 635002
Cincinnati, OH 45263-5002
Phone (800) 424-3672

Other identifiers 2

IdentifierTypeStateIssuer
46732OtherFLBLUE SHIELD
256533100MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mweiss5138@MHSDIRECT.NET

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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

Enrollment IDStateProvider typePAC IDDetails
I20050512000905 FL Practitioner - Pediatric MedicinePractitioner - Emergency Medicine 6305887068 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME75622FLMDPediatric Emergency Medicine (Pediatrics) Physician

Interoperability endpoints

  • Direct secure messaging: mweiss5138@mhsdirect.net

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": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616976000000",
    "number": "1780612028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 635002",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452635002",
            "telephone_number": "800-424-3672",
            "fax_number": "954-377-3042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3501 JOHNSON STREEET",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "33021",
            "telephone_number": "954-987-2000",
            "fax_number": "954-985-3453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEISS",
        "first_name": "MICHAEL",
        "middle_name": "ERIC",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME75622",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "FL",
            "license": "ME75622",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "46732",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256533100",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mweiss5138@MHSDIRECT.NET",
            "affiliation": "N",
            "address_1": "3501 Johnson Streeet",
            "city": "Hollywood",
            "state": "FL",
            "country_code": "US",
            "postal_code": "33021",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hollywood, FL

Sources for this page

Verify at the official NPI Registry.