Krishna P Jetti, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

MD038024L Issued in PA

Practice address

12279 Route 30
Ste 200
North Huntingdon, PA 15642-1849

Phone

(724) 864-4470

Fax

(724) 863-7120

NPI assigned

Aug 2, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in PA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Interoperability endpoints

• Direct secure messaging: kjetti@direct.excelahealth.org

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1360800000000",
    "number": "1740297399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12279 ROUTE 30",
            "address_2": "STE 200",
            "city": "NORTH HUNTINGDON",
            "state": "PA",
            "postal_code": "156421849",
            "telephone_number": "724-864-4470",
            "fax_number": "724-863-7120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12279 ROUTE 30",
            "address_2": "STE 200",
            "city": "NORTH HUNTINGDON",
            "state": "PA",
            "postal_code": "156421849",
            "telephone_number": "724-864-4470",
            "fax_number": "724-863-7120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JETTI",
        "first_name": "KRISHNA",
        "middle_name": "P",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2013-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "MD038024L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BS",
            "identifier": "JE55077",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPNCE",
            "identifier": "100159",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0009633780001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Surgery Physician in North Huntingdon, PA
• Providers in North Huntingdon, PA by specialty
• Surgery Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 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.