NPIMap

Individual provider Active NPI

John Henry Weller, FNPC

  • Family Nurse Practitioner
  • Salem, OR
National Provider Identifier
1871538819
Registry record updated Jul 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
200150116NP Issued in OR
Practice address
1095 Liberty St NE
Ste a
Salem, OR 97301-1137
Phone
(503) 581-6550
Fax
(503) 581-4755
NPI assigned
Jun 16, 2006
Last updated
Jul 25, 2013By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 25, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 200150116NP OR Primary

Addresses

Primary practice location

1095 Liberty St NE
Ste a
Salem, OR 97301-1137

Mailing address

1095 Liberty St NE
Salem, OR 97301-1137
Phone (503) 581-6550

Other identifiers 1

IdentifierTypeStateIssuer
210854MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
200150116NPORMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Brookdale Senior Living Communities, Inc. Past Accepting new patients
Lancaster Medical Clinic Past Accepting new patients
Peacehealth Past Accepting new patients
Peacehealth Past Accepting new patients
Lloyd Center Medical Clinic PC Past Accepting new patients

Organizations & group practices 6

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": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374710400000",
    "number": "1871538819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1095 LIBERTY ST NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973011137",
            "telephone_number": "503-581-6550",
            "fax_number": "503-581-4755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1095 LIBERTY ST NE",
            "address_2": "STE A",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973011137",
            "telephone_number": "503-581-6550",
            "fax_number": "503-581-4755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELLER",
        "first_name": "JOHN",
        "middle_name": "HENRY",
        "credential": "FNPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2013-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "200150116NP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "210854",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 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.