Jack E Weaver, MD PC

Primary specialty

Sports Medicine (Internal Medicine) PhysicianTaxonomy code 207RS0010X

Legal business name

JACK E WEAVER, MD PC

Practice address

209 S 36TH St
Muskogee, OK 74401-5043

Phone

(918) 682-7717

Fax

(918) 682-9434

NPI assigned

Sep 22, 2010

Last updated

Aug 25, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jack E Weaver, MDNPI 1902802101

Title

Owner

Phone

(918) 682-7717

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OK2 enrollments

Enrollment records 2

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Jack Eugene Weaver, MD

  • Interventional Pain Medicine Physician
  • Muskogee, OK
  • NPI 1902802101

  O20100930098570

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jack Eugene Weaver, MD

  • Interventional Pain Medicine Physician
  • Muskogee, OK
  • NPI 1902802101

  Family Medicine

  Medicare reassignment NPD Authorized official
• Michelle B Perry, APRN

  • Family Nurse Practitioner
  • Coffeyville, KS
  • NPI 1487021580

  OK

  Medicare reassignment NPD

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

{
    "created_epoch": "1285113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440460800000",
    "number": "1841508918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 S 36TH ST",
            "city": "MUSKOGEE",
            "state": "OK",
            "postal_code": "744015043",
            "telephone_number": "918-682-7717",
            "fax_number": "918-682-9434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 S 36TH ST",
            "city": "MUSKOGEE",
            "state": "OK",
            "postal_code": "744015043",
            "telephone_number": "918-682-7717",
            "fax_number": "918-682-9434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK E WEAVER, MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-22",
        "last_updated": "2015-08-25",
        "status": "A",
        "authorized_official_last_name": "WEAVER",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-682-7717",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RS0010X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100088830A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• J David Wayman MD PLLC
• J S Rutherford MD PC
• J'Dene Michelle Rogers (Integrity Pathways)
• Jack C. Montgomery VA Medical Center
• Jack C. Montgomery VA Medical Center
• Jackie Fields Foundation
• Margo Jackson-Lockyer, MD
• Lisa Jackson, PRSS
• Nancy Lee Jackson, R.N.
• Paige Nicole Jackson

• Sports Medicine (Internal Medicine) Physician in Muskogee, OK
• Providers in Muskogee, OK by specialty
• Sports Medicine (Internal Medicine) Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.