Jaclyn Weber, PA
Individual provider Active NPI Physician Assistant · New Boston, MI
NPI 1992371702 · NPPES record last updated Apr 14, 2022
Key facts
- NPI
- 1992371702
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 5601010586 (MI)
- Practice address
- 17901 Huron River Dr
New Boston, MI 48164-3200 - Phone
- (734) 315-7070
- NPI assigned
- Jun 2, 2021
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Wayne State University School of Medicine, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Medpro Primary Care PLLC
Practice addresses (Care Compare)
21057 Waltz Rd
New Boston, MI 48164-9164
Phone (734) 606-5273
Hospital & facility affiliations
- Northwestern Medicine Central Dupage Hospital
- Corewell Health Wayne Hospital
- St Joe Mercy Hospital System Livonia
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210628002039 | MI | Practitioner - Physician Assistant | 3870994817 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601010586 | MI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medpro Urgent Care PLLC | Past | Accepting new patients |
Interoperability endpoints
- jaclyn.fritz.1@21116.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601010586 | MI | Yes |
Addresses
Primary practice location
17901 Huron River Dr
New Boston, MI 48164-3200
Mailing address
16825 Abby Cir
Northville, MI 48168-4303
Phone (248) 444-9097
Other providers in New Boston, MI
- The Speech and Language Advocacy Center
- Toms P. Mathew M.D., P.C.
- Vijayalakshmi Nagappan MD PC
- Voreis Eye Care, P.C.
- Paul Kent Voreis
- David Barry Wiss
All providers in New Boston, MI · Physician Assistant in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 14, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.