NPIMap

Individual provider Active NPI

Judith K Weis, M.D.

  • Family Medicine Physician
  • Mascoutah, IL
National Provider Identifier
1942252226
Registry record updated Dec 17, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036089439 Issued in IL
Practice address
739 N Jefferson St
Suite 200
Mascoutah, IL 62258-1447
Phone
(618) 566-8810
Fax
(618) 566-7121
NPI assigned
May 16, 2006
Last updated
Dec 17, 2009By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 17, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036089439 IL Primary

Addresses

Primary practice location

739 N Jefferson St
Suite 200
Mascoutah, IL 62258-1447

Mailing address

739 N Jefferson St
Suite 200
Mascoutah, IL 62258-1447
Phone (618) 566-8810

Other identifiers 1

IdentifierTypeStateIssuer
036089439MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20100813000482 IL Practitioner - Family Practice 4789631557 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Southern Illinois University School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lincoln Surgical Associates, LTD.Group PAC ID 9335320597, 25 clinicians

Practice addresses (Care Compare)

1414 Cross St
Shiloh, IL 62269-2941
Phone (618) 277-7400

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions23
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036089439ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lincoln Surgical Associates, LTD. Family Medicine CurrentSince Jan 1, 2025 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

251 Marketplace Dr
#1
Freeburg, IL 62243
Phone (618) 539-0067

739 N Jefferson St
#200
Mascoutah, IL 62258
Phone (618) 566-8810

1414 Cross St
Ste 330
Shiloh, IL 62269
Phone (618) 228-8610

Organizations & group practices 3

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 12

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

NPI Registry JSON

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1261008000000",
    "number": "1942252226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "739 N JEFFERSON ST",
            "address_2": "SUITE 200",
            "city": "MASCOUTAH",
            "state": "IL",
            "postal_code": "622581447",
            "telephone_number": "618-566-8810",
            "fax_number": "618-566-7121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "739 N JEFFERSON ST",
            "address_2": "SUITE 200",
            "city": "MASCOUTAH",
            "state": "IL",
            "postal_code": "622581447",
            "telephone_number": "618-566-8810",
            "fax_number": "618-566-7121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEIS",
        "first_name": "JUDITH",
        "middle_name": "K",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-16",
        "last_updated": "2009-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036089439",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036089439",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mascoutah, IL

Sources for this page

Verify at the official NPI Registry.