Active NPI
Michael T Weiss, NP
- Family Nurse Practitioner
- Chicago, IL
National Provider Identifier
1992420822
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 2022057127
- Practice address
- 4927 N Washtenaw Ave
Chicago, IL 60625-7091 - Phone
- (630) 835-8443
- NPI assigned
- Oct 4, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 2022057127 | IL | Primary |
Addresses
Primary practice location
4927 N Washtenaw Ave
Chicago, IL 60625-7091
Mailing address
50 S B B King Blvd Ste 100
Memphis, TN 38103-9802
Phone (901) 436-1381
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230830002547 | IL | Order and Referring Only - Nurse Practitioner | 1850754482 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2022057127 | IL | MD | Family Nurse Practitioner |
Interoperability endpoints
- ms_mweiss22@landmarkhealth-direct.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666828800000",
"number": "1992420822",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "50 S B B KING BLVD STE 100",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381039802",
"telephone_number": "901-436-1381"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4927 N WASHTENAW AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606257091",
"telephone_number": "630-835-8443"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEISS",
"first_name": "MICHAEL",
"middle_name": "T",
"credential": "NP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-10-04",
"last_updated": "2022-10-27",
"certification_date": "2022-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "IL",
"license": "2022057127",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2022; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.