NPIMap

Individual provider Active NPI

Tad A Yetter, M.D.

  • Internal Medicine Physician
  • Havana, IL
National Provider Identifier
1245296979
Registry record updated Jun 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036079681 Issued in IL
Practice address
615 N Promenade St
Havana, IL 62644-1015
Phone
(309) 543-6600
Fax
(309) 543-2089
NPI assigned
Apr 21, 2006
Last updated
Jun 1, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036079681 IL Primary

Addresses

Primary practice location

615 N Promenade St
Havana, IL 62644-1015

Mailing address

615 N Promenade St
P O Box 530
Havana, IL 62644-1015
Phone (309) 543-6600

Other identifiers 1

IdentifierTypeStateIssuer
036079681MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100508000142 IL Practitioner - Internal Medicine 5496749657 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Southern Illinois University School of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Proctor Health SystemsGroup PAC ID 3476440173, 131 clinicians
Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians

Practice addresses (Care Compare)

2076 N Main St
Canton, IL 61520-1054
Phone (309) 647-6090

611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753

815 Main St
Peoria, IL 61602-1076
Phone (309) 672-4977

815 Main St
Suite a
Peoria, IL 61602-1080
Phone (309) 672-4977

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions18
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy16

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Schuyler County Hospital District CurrentSince May 1, 2023 Accepting new patients
Proctor Health Systems Internal Medicine CurrentSince May 1, 2023 Accepting new patients
Carle Health Medical Group Internal Medicine CurrentSince Jan 1, 2026 Accepting new patients
Methodist Medical Center of Illinois CurrentSince Jul 1, 2025 Accepting new patients
Methodist Medical Center of Illinois Internal Medicine CurrentSince Jul 1, 2025 Accepting new patients
Schuyler County Hospital District CurrentSince May 1, 2023 Accepting new patients
Proctor Health Systems CurrentSince May 1, 2023 Accepting new patients
Methodist Medical Center of Illinois Current Accepting new patients

Locations

2076 N Main St
Canton, IL 61520
Phone (309) 647-6090

158 E Fulton St
Farmington, IL 61531
Phone (309) 245-2416

221 NE Glen Oak Ave
Peoria, IL 61636
Phone (309) 672-4281

5401 N Knoxville Ave
Ste 400
Peoria, IL 61614
Phone (309) 691-6610

815 Main St
Ste A
Peoria, IL 61602
Phone (309) 671-3000

815 Main St
Ste A1
Peoria, IL 61602

238 S Congress St
Rushville, IL 62681
Phone (217) 322-4321

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

Organizations & group practices 8

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.

Hospital & facility affiliations 4

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": "1145577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338508800000",
    "number": "1245296979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 N PROMENADE ST",
            "address_2": "P O BOX 530",
            "city": "HAVANA",
            "state": "IL",
            "postal_code": "626441015",
            "telephone_number": "309-543-6600",
            "fax_number": "309-543-2089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 N PROMENADE ST",
            "city": "HAVANA",
            "state": "IL",
            "postal_code": "626441015",
            "telephone_number": "309-543-6600",
            "fax_number": "309-543-2089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YETTER",
        "first_name": "TAD",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-21",
        "last_updated": "2012-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036079681",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036079681",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Havana, IL

Sources for this page

Verify at the official NPI Registry.