Jeremy Blake Weaver, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-843 Issued in AR

Practice address

620 Broadway St
Van Buren, AR 72956-5830

Phone

(479) 474-5061

Fax

(479) 922-2007

NPI assigned

Dec 9, 2009

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 AR

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

Specialty

Physician Assistant

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sophia Meyer Family Medicine LLCGroup PAC ID 9537317219, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baptist Health - Fort Smith Hospital, Fort Smith, AR, CCN 040055
• Mercy Hospital Fort Smith Hospital, Fort Smith, AR, CCN 040062

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sophia Meyer Family Medicine LLC

  • Family Medicine Physician
  • Van Buren, AR
  • NPI 1083834378
  Medicare reassignment Care Compare group

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

• Baptist Health Regional Hospitals

  • General Acute Care Hospital
  • Fort Smith, AR
  • NPI 1710463146
  Care Compare affiliation
• Mercy Hospital Fort Smith

  • General Acute Care Hospital
  • Fort Smith, AR
  • NPI 1568433480
  Care Compare affiliation

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

{
    "created_epoch": "1260316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611619200000",
    "number": "1790014447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 BROADWAY ST",
            "city": "VAN BUREN",
            "state": "AR",
            "postal_code": "729565830",
            "telephone_number": "479-474-5061",
            "fax_number": "479-922-2007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 BROADWAY ST",
            "city": "VAN BUREN",
            "state": "AR",
            "postal_code": "729565830",
            "telephone_number": "479-474-5061",
            "fax_number": "479-922-2007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEAVER",
        "first_name": "JEREMY",
        "middle_name": "BLAKE",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-12-09",
        "last_updated": "2021-01-26",
        "certification_date": "2021-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA06492",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AR",
            "license": "PA-843",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katie Dawn Warren
• Julie Watson
• Elizabeth Emily Chugg Watters, LCSW
• Stacy Watts
• Danielle Yvonne Weaver, APRN
• Scott Welch II
• Wes McCabe
• Western Arkansas Orthopedic Clinic,PLLC
• Whitney D Wewer
• Michelle Wewers

• Physician Assistant in Van Buren, AR
• Providers in Van Buren, AR by specialty
• Physician Assistant in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.