JACK R WEITZ PHD PA
NPI 1063579662
Psychologist in N Miami Beach, FL

Active since January 02, 2007
1021 IVES DAIRY RD, BLDG 3 SUITE 119, N MIAMI BEACH, FL 33179(305) 655-2335(305) 652-5759 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Jack R Weitz Phd Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACK R WEITZ PHD PA (NPI 1063579662) is a healthcare organization registered as a psychologist in N Miami Beach, Florida and active in the NPI registry since January 2007. The organization lists Jack Robert Weitz, President Psychologist, as its authorized official.

NPPES Registry Identity

NPI1063579662
Entity TypeOrganization
Primary Taxonomy103T00000X
Legal Business NameJACK R WEITZ PHD PA
Location Address1021 IVES DAIRY RD, BLDG 3 SUITE 119N Miami Beach, FL 33179
Mailing Address1021 Ives Dairy Rd, Bldg 3 Suite 119N Miami Beach, FL 33179 · (305) 655-2335 · Fax (305) 652-5759
Fax(305) 652-5759
Organization SubpartNo
Authorized OfficialJack Robert WeitzPresident Psychologist · (305) 655-2335
Enumeration DateJanuary 2, 2007
Last NPPES UpdateAugust 22, 2020
✔ NPI 1063579662 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License✔ Licensed in FL · PY4345
Definition
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
1021 IVES DAIRY RD, N Miami Beach, FL 33179

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jack R Weitz Phd Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Jack R Weitz Phd PA, which bills Medicare for the services this clinician delivers.

Clinician (1)

Clinical Psychologist
NPI 1407904873
1021 IVES DARRY RD BLDG 3 SUITE 119
North Miami Beach, FL 33179
(305) 655-2335
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jack R Weitz Phd PA's NPI number?

The NPI number for Jack R Weitz Phd PA is 1063579662. It was assigned to this organization in the NPPES registry on January 2, 2007.

Where is Jack R Weitz Phd PA located?

Jack R Weitz Phd PA is located at 1021 Ives Dairy Rd Bldg 3 Suite 119, N Miami Beach, FL 33179. The listed phone number is (305) 655-2335.

What is Jack R Weitz Phd PA's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Jack R Weitz Phd PA enrolled in Medicare?

Yes. Jack R Weitz Phd PA is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Jack R Weitz Phd PA?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Clinical Psychologist) reassigns their Medicare billing to Jack R Weitz Phd PA. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Jack R Weitz Phd PA was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.