Individual provider Active NPI

Thomas Jetmore, M.D.

  • Otolaryngology Physician
  • Richmond, IN
National Provider Identifier
1104274463
Registry record updated Sep 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
01086136A Issued in IN
Practice address
1434 Chester Blvd
Richmond, IN 47374-1947
Phone
(765) 966-1600
Fax
(765) 962-9641
NPI assigned
May 27, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 01086136A IN Primary

Addresses

Primary practice location

1434 Chester Blvd
Richmond, IN 47374-1947

Mailing address

1100 Reid Pkwy
Richmond, IN 47374-1157
Phone (765) 966-1600

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tjetmore436193@ReidHealth.direct-ci.com Reid Physician Associates, Inc.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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

Enrollment IDStateProvider typePAC IDDetails
I20210629002958 IN Practitioner - Otolaryngology 9436550308 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Indiana University School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Reid Physician Associates IncGroup PAC ID 6406910769, 427 clinicians

Practice addresses (Care Compare)

1100 Reid Pkwy
Richmond, IN 47374-1157

1434 Chester Blvd
Richmond, IN 47374-1947
Phone (765) 966-1600

1475 E State Rd 44
3 Spec Care Connersv
Connersville, IN 47331-0219
Phone (765) 825-8686

2500 N Park Rd
Reid Health
Connersville, IN 47331-3040
Phone (765) 983-3000

4829 N State Rd
1 Reid Health Prim and Spec Care Hagers
Hagerstown, IN 47346-9620
Phone (765) 489-3935

Hospital & facility affiliations

  • Reid Health Hospital, Richmond, IN, CCN 150048
  • Henry County Memorial Hospital Hospital, New Castle, IN, CCN 150030

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01086136AINMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Reid Physician Associates, Inc. CurrentSince Jul 19, 2021 Accepting new patients
Reid Physician Associates, Inc CurrentSince Jul 19, 2021 Accepting new patients

Locations

1475 E State Road 44
Ste 3
Connersville, IN 47331
Phone (765) 825-8686

4829 N State Road 1
Hagerstown, IN 47346
Phone (765) 489-3935

1434 Chester Blvd
Richmond, IN 47374
Phone (765) 966-1600

1100 Reid Pkwy
Richmond, IN 47374
Phone (765) 983-3000

Interoperability endpoints

  • Direct secure messaging: tjetmore436193@reidhealth.direct-ci.com

Organizations & group practices 2

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": "1464307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632355200000",
    "number": "1104274463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 REID PKWY",
            "city": "RICHMOND",
            "state": "IN",
            "postal_code": "473741157",
            "telephone_number": "765-966-1600",
            "fax_number": "765-962-9641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1434 CHESTER BLVD",
            "city": "RICHMOND",
            "state": "IN",
            "postal_code": "473741947",
            "telephone_number": "765-966-1600",
            "fax_number": "765-962-9641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JETMORE",
        "first_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-27",
        "last_updated": "2021-09-23",
        "certification_date": "2021-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "IN",
            "license": "01086136A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tjetmore436193@ReidHealth.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "Reid Physician Associates, Inc.",
            "address_1": "1434 Chester Blvd",
            "city": "Richmond",
            "state": "IN",
            "country_code": "US",
            "postal_code": "473741947",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Richmond, IN

Sources for this page

Verify at the official NPI Registry.