Individual provider Active NPI

Jaykumar Chandrakant Ghetia, MD

  • Student in an Organized Health Care Education/Training Program
  • Marshfield, WI
National Provider Identifier
1679252340
Registry record updated Jul 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
100036-851 Issued in WI
Practice address
1000 N Oak Ave
Marshfield, WI 54449-5702
Phone
(715) 387-5251
Fax
(715) 389-4746
NPI assigned
Jul 11, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 100036-851 WI Primary

Addresses

Primary practice location

1000 N Oak Ave
Marshfield, WI 54449-5702

Mailing address

1626 N Fig Ave Apt 218
Marshfield, WI 54449-1400
Phone (715) 502-2005

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20241127002049 WI Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 1153856117

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
100036-851WIMDStudent in an Organized Health Care Education/Training Program

NPI Registry JSON

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

{
    "created_epoch": "1689033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689033600000",
    "number": "1679252340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1626 N FIG AVE APT 218",
            "city": "MARSHFIELD",
            "state": "WI",
            "postal_code": "544491400",
            "telephone_number": "715-502-2005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 N OAK AVE",
            "city": "MARSHFIELD",
            "state": "WI",
            "postal_code": "544495702",
            "telephone_number": "715-387-5251",
            "fax_number": "715-389-4746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHETIA",
        "first_name": "JAYKUMAR",
        "middle_name": "CHANDRAKANT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-07-11",
        "last_updated": "2023-07-11",
        "certification_date": "2023-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "WI",
            "license": "100036-851",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marshfield, WI

Sources for this page

Verify at the official NPI Registry.