Ajay Jeetwani, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

036.130636 Issued in IL

Practice address

4 Doctors Park
Gibson City, IL 60936-2000

Phone

(217) 784-4540

Fax

(217) 784-4542

NPI assigned

Aug 12, 2009

Last updated

Sep 11, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Illinois Department of Human Services

  • Intellectual Disabilities Intermediate Care Facility
  • Centralia, IL
  • NPI 1003960394
  NPD
• Illinois Department of Human Services

  dba Andrew McFarland Mental Health Center

  • Psychiatric Hospital
  • Springfield, IL
  • NPI 1467430124
  NPD
• Illinois Department of Human Services

  dba John J Madden Mental Health

  • Psychiatric Hospital
  • Hines, IL
  • NPI 1902903487
  NPD

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

{
    "created_epoch": "1250035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378857600000",
    "number": "1205068053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 DOCTORS PARK",
            "city": "GIBSON CITY",
            "state": "IL",
            "postal_code": "609362000",
            "telephone_number": "217-784-4540",
            "fax_number": "217-784-4542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 DOCTORS PARK",
            "city": "GIBSON CITY",
            "state": "IL",
            "postal_code": "609362000",
            "telephone_number": "217-784-4540",
            "fax_number": "217-784-4542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEETWANI",
        "first_name": "AJAY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-12",
        "last_updated": "2013-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036.130636",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heritage Manor - Gibson City, LLC (Heritage Health)
• Heritage Manor - Gibson City, LLC (Heritage Health - Gibson City)
• Diane Beth Heyman
• Joel G Hirschfeld, MSPT
• Mary Elisabeth Jacobson
• Elizabeth Benita Jennings, INTERPRETER
• Abby M Johnson
• Anita L Johnson, AUD
• Kahlee Jones, NP
• Joseph Chung, MD

• Psychiatry Physician in Gibson City, IL
• Providers in Gibson City, IL by specialty
• Psychiatry Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2013; 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.

Verify at the official NPI Registry.