NPIMap

Individual provider Active NPI

Jeffrey Ross Weis, M.D.

  • Ophthalmology Physician
  • Hermantown, MN
National Provider Identifier
1821183815
Registry record updated Jul 6, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
42784 Issued in MN
Practice address
4815 W Arrowhead Rd
Suite 120
Hermantown, MN 55811-4004
Phone
(218) 625-1917
Fax
(218) 625-7182
NPI assigned
Oct 4, 2006
Last updated
Jul 6, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 42784 MN Primary

Addresses

Primary practice location

4815 W Arrowhead Rd
Suite 120
Hermantown, MN 55811-4004

Mailing address

4815 W Arrowhead Rd
Suite 120
Hermantown, MN 55811-4004
Phone (218) 625-1917

Other identifiers 1

IdentifierTypeStateIssuer
246970700MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101025001121 MN Practitioner - Ophthalmology 3870662380 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
University of Minnesota Medical School, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4815 W Arrowhead Rd
Hermantown, MN 55811-4008
Phone (218) 625-1917

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery192

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Weis Eye Center CurrentSince Jun 30, 2010 Accepting new patients
St. Luke's Hospital of Duluth Current Accepting new patients
Northern Refractive Surgery Center LTD Ophthalmology PastSince Aug 1, 2001 Accepting new patients

Locations

1001 Cloquet Ave
Cloquet, MN 55720
Phone (218) 625-1917

4815 W Arrowhead Rd
Hermantown, MN 55811
Phone (218) 625-1917

4815 W Arrowhead Rd
Ste 120
Hermantown, MN 55811
Phone (218) 625-1917

Interoperability endpoints

  • Direct secure messaging: jeffrey.weis.weije@slk.direct.slhduluth.com

Organizations & group practices 4

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 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278374400000",
    "number": "1821183815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4815 W ARROWHEAD RD",
            "address_2": "SUITE 120",
            "city": "HERMANTOWN",
            "state": "MN",
            "postal_code": "558114004",
            "telephone_number": "218-625-1917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4815 W ARROWHEAD RD",
            "address_2": "SUITE 120",
            "city": "HERMANTOWN",
            "state": "MN",
            "postal_code": "558114004",
            "telephone_number": "218-625-1917",
            "fax_number": "218-625-7182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEIS",
        "first_name": "JEFFREY",
        "middle_name": "ROSS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2010-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MN",
            "license": "42784",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "246970700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hermantown, MN

Sources for this page

Verify at the official NPI Registry.