Individual provider Active NPI

Melissa Brandon Weimer, D.O.

  • Addiction Medicine (Internal Medicine) Physician
  • New Haven, CT
National Provider Identifier
1972708675
Registry record updated Jun 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X
License
61845 Issued in CT
Practice address
1450 Chapel St
New Haven, CT 06511-4405
Phone
(203) 789-3160
NPI assigned
Jun 20, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X DO28980 OR
Internal Medicine Physician 207R00000X 61845 CT
Addiction Medicine (Internal Medicine) Physician 207RA0401X 287202 NY
Addiction Medicine (Internal Medicine) Physician 207RA0401X 61845 CT Primary

Addresses

Primary practice location

1450 Chapel St
New Haven, CT 06511-4405

Mailing address

367 Cedar St RM 417a
New Haven, CT 06510-3222
Phone (203) 785-4485

Other practice location 1

315 S Manning Blvd
Albany, NY 12208-1707
Phone (518) 525-6079

Other identifiers 1

IdentifierTypeStateIssuer
287202OtherNYNY STATE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address payer.credentialing@sphp.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, CT2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20170119002733 NY Practitioner - Addiction Medicine 8022162726 Reassigns benefits to 1 organization
I20181003001957 CT Practitioner - Internal MedicinePractitioner - Addiction Medicine 8022162726 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Addiction Medicine
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Yale UniversityGroup PAC ID 9436061736, 2,632 clinicians

Practice addresses (Care Compare)

1450 Chapel St
New Haven, CT 06511-4440
Phone (203) 789-3000

Hospital & facility affiliations

  • Yale-New Haven Hospital Hospital, New Haven, CT, CCN 070022

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
61845CTMDAddiction Medicine (Internal Medicine) Physician
287202NYMDAddiction Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Yale University CurrentSince Sep 13, 2018 Accepting new patients
St. Peter'S Hospital of the City of Albany Internal Medicine CurrentSince Feb 27, 2017 Accepting new patients
Mill Hill Medical Consultants Inc CurrentSince Apr 1, 2020 Accepting new patients
Yale University Internal Medicine CurrentSince Sep 13, 2018 Accepting new patients
St. Peter'S Hospital of the City of Albany Internal Medicine CurrentSince Feb 27, 2017 Accepting new patients
Northeast Medical Group, Inc. Internal Medicine CurrentSince Apr 1, 2020 Accepting new patients
Central City Concern, Inc Past Accepting new patients
Central City Concern Past Accepting new patients

Locations

300 George St
Fl 6
New Haven, CT 06511
Phone (203) 785-6610

1450 Chapel St
New Haven, CT 06511
Phone (203) 789-3151

800 Howard Ave
New Haven, CT 06519
Phone (203) 785-2140

367 Cedar St
Rm 417A
New Haven, CT 06510

20 York St
Unit CB2041
New Haven, CT 06510
Phone (203) 688-4741

95 Armory Rd
Stratford, CT 06614
Phone (203) 384-3388

315 S Manning Blvd
Albany, NY 12208
Phone (518) 525-1852

Interoperability endpoints

  • Direct secure messaging: mweimer788733@direct.trinity-health.org
  • Direct secure messaging: mweimer406828@direct.ynhh.org

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1182297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622505600000",
    "number": "1972708675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "367 CEDAR ST RM 417A",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065103222",
            "telephone_number": "203-785-4485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 CHAPEL ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065114405",
            "telephone_number": "203-789-3160"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "315 S Manning Blvd",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "NY",
            "postal_code": "122081707",
            "country_code": "US",
            "telephone_number": "518-525-6079",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WEIMER",
        "first_name": "MELISSA",
        "middle_name": "BRANDON",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-20",
        "last_updated": "2021-06-01",
        "certification_date": "2021-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "DO28980",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "61845",
            "primary": false
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "NY",
            "license": "287202",
            "primary": false
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "CT",
            "license": "61845",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NY STATE",
            "identifier": "287202",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "payer.credentialing@sphp.com",
            "affiliation": "N",
            "endpointDescription": "SPHP - Payer Credentialing",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "315 S Manning Blvd",
            "city": "Albany",
            "state": "NY",
            "country_code": "US",
            "postal_code": "122081707",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in New Haven, CT

Sources for this page

Verify at the official NPI Registry.