Jetty Heart Clinic

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

01040154A Issued in IN

Legal business name

JETTY HEART CLINIC

Practice address

1210 B Medical Arts Boulevard
Suite 217
Anderson, IN 46011-3439

Phone

(765) 298-4422

Fax

(765) 298-4926

NPI assigned

Jan 29, 2008

Organization subpart

No

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

Authorized official

Name

Preetham Jetty, MD

Title

Owner

Phone

(765) 298-4422

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1201564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224720000000",
    "number": "1205013653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1210 B MEDICAL ARTS BOULEVARD",
            "address_2": "SUITE 217",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460113439",
            "telephone_number": "765-298-4422",
            "fax_number": "765-298-4926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 B MEDICAL ARTS BOULEVARD",
            "address_2": "SUITE 217",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460113439",
            "telephone_number": "765-298-4422",
            "fax_number": "765-298-4926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JETTY HEART CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-29",
        "last_updated": "2008-10-23",
        "status": "A",
        "authorized_official_last_name": "JETTY",
        "authorized_official_first_name": "PREETHAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "765-298-4422",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IN",
            "license": "01040154A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200886890",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeffrey M. Blake MD, Inc.
• Mark Randall Jennings, MD
• Eunmi Wang Jeong, OTA
• Joseph G. Jerman, MD
• Jerry D Warthman, O.D., LLC
• Jetty Heart Clinic of the Indiana Heart Hospital LLC
• Preetham Jetty, MD
• Audre N Johnson, NP
• Grace Rebekah Johnson
• Greg Johnson, LSW

• Cardiovascular Disease Physician in Anderson, IN
• Providers in Anderson, IN by specialty
• Cardiovascular Disease Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.