NPIMap

Organization Active NPI

Jere H. Weaver

  • Dermatology Physician
  • Decatur, AL
National Provider Identifier
1851573778
Registry record updated Sep 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
11631 Issued in AL
Legal business name
JERE H. WEAVER
Practice address
722 Bank St NE
Decatur, AL 35601-1610
Phone
(256) 351-1874
Fax
(256) 351-1876
NPI assigned
Dec 3, 2007
Last updated
Sep 23, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2013

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

Authorized official

Name
Jere H. Weaver, MDNPI 1265436067
Title
MD/Owner
Phone
(256) 351-1874

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 11631 AL Primary

Addresses

Primary practice location

722 Bank St NE
Decatur, AL 35601-1610

Mailing address

722 Bank St NE
Decatur, AL 35601-1610
Phone (256) 351-1874

Other identifiers 3

IdentifierTypeStateIssuer
009912888MedicaidAL
515-97711OtherALBLUE CROSS BLUE SHIELD
51025264OtherALBLUE CROSS PROVIDER NUMBE

National Provider Directory

National Provider Directory

Locations

802 Bank St NE
Decatur, AL 35601
Phone (256) 351-1874

722 Bank St NE
Decatur, AL 35601
Phone (256) 351-1874

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1196640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379894400000",
    "number": "1851573778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "722 BANK ST NE",
            "city": "DECATUR",
            "state": "AL",
            "postal_code": "356011610",
            "telephone_number": "256-351-1874",
            "fax_number": "256-351-1876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "722 BANK ST NE",
            "city": "DECATUR",
            "state": "AL",
            "postal_code": "356011610",
            "telephone_number": "256-351-1874",
            "fax_number": "256-351-1876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERE H. WEAVER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-03",
        "last_updated": "2013-09-23",
        "status": "A",
        "authorized_official_last_name": "WEAVER",
        "authorized_official_first_name": "JERE",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "256-351-1874",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "AL",
            "license": "11631",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009912888",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "515-97711",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER NUMBE",
            "identifier": "51025264",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.