Gerald Edward Weaver, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

MD60398142 Issued in WA

Practice address

176 1St Ave N
Ilwaco, WA 98624-9137

Phone

(360) 642-3747

Fax

(360) 642-3361

NPI assigned

Jul 7, 2006

Last updated

May 21, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

General SurgeryAlso: Vascular Surgery

Education

Loma Linda University School of Medicine, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Public Hospital District 3 of Pacific CountyGroup PAC ID 7214822105, 25 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ocean Beach Hospital Hospital, Ilwaco, WA, CCN 501314

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: gweaver831502@ak.providencedirect.org
• Direct secure messaging: gweaver831547@oc.providencedirect.org

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.

• Public Hospital District 3 of Pacific County

  dba Ocean Beach Hospital

  • Critical Access Hospital
  • Ilwaco, WA
  • NPI 1295771376
  Medicare reassignment Care Compare group NPD
• Public Hospital District 3 of Pacific County

  dba Ocean Beach Medical Group -Ocean Park

  • Rural Health Clinic/Center
  • Ocean Park, WA
  • NPI 1417482191
  NPD
• Public Hospital District 3 of Pacific County

  dba Ocean Beach Medical Clinic

  • Rural Health Clinic/Center
  • Iiwaco, WA
  • NPI 1639165905
  NPD

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

• Public Hospital District 3 of Pacific County

  dba Ocean Beach Hospital

  • Critical Access Hospital
  • Ilwaco, WA
  • NPI 1295771376
  Care Compare affiliation

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590019200000",
    "number": "1952333221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "176 1ST AVE N",
            "address_2": "OCEAN BEACH MEDICAL CLINIC",
            "city": "ILWACO",
            "state": "WA",
            "postal_code": "986249137",
            "telephone_number": "360-642-3747",
            "fax_number": "360-642-3361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "176 1ST AVE N",
            "city": "ILWACO",
            "state": "WA",
            "postal_code": "986249137",
            "telephone_number": "360-642-3747",
            "fax_number": "360-642-3361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEAVER",
        "first_name": "GERALD",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2020-05-21",
        "certification_date": "2020-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WY",
            "license": "5731A",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WA",
            "license": "MD60398142",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MC PTAN G000802400",
            "identifier": "G000802400",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1952333221",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gweaver831502@ak.providencedirect.org",
            "affiliation": "N",
            "address_1": "176 1st Ave N",
            "city": "Ilwaco",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986249137",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lindy Danielle Wood Swain, PHARMD
• Gloria Vandehey, RN-CDE
• Keli Marie Vasquez, AGENCY AFFILIATED CO
• Victoria Margaret Vestal, LPTBD
• Mark J Waliser, MD

• Surgery Physician in Ilwaco, WA
• Providers in Ilwaco, WA by specialty
• Surgery Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.