Individual provider Active NPI

Carroll Robert Wetzel, M.D.

  • Surgery Physician
  • Clinton, MO
National Provider Identifier
1841212362
Registry record updated Nov 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
R2H39 Issued in MO
Practice address
1602 N 2ND St
Clinton, MO 64735-1192
Phone
(660) 885-8171
Fax
(660) 890-8490
NPI assigned
Jul 24, 2006
Last updated
Nov 16, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X R2H39 MO Primary

Addresses

Primary practice location

1602 N 2ND St
Clinton, MO 64735-1192

Mailing address

1602 N 2ND St
Clinton, MO 64735-1192
Phone (660) 885-8171

Other practice location 1

603 E Gaines Dr
Clinton, MO 64735-3205
Phone (660) 885-8141

Other identifiers 1

IdentifierTypeStateIssuer
206786600MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address robwetzel@mhccaremail.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20050222000886 MO Practitioner - General Surgery 9830142546 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Tulane University School of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1600 N 2ND St
Clinton, MO 64735-1192
Phone (660) 885-5511

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy83
Hernia repair (minimally invasive)1-10
Mastectomy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux65
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Golden Valley Memorial Hospital District Current Accepting new patients
Golden Valley Memorial Hospital District CurrentSince Jan 1, 2019 Accepting new patients
Golden Valley Memorial Hospital District CurrentSince Jan 1, 2019 Accepting new patients
Golden Valley Memorial Hospital District Past Accepting new patients

Locations

1600 N 2nd St
Clinton, MO 64735
Phone (660) 885-8171

1602 N 2nd St
Clinton, MO 64735
Phone (660) 885-8171

1701 N 2nd St
Clinton, MO 64735
Phone (660) 885-8171

603 E Gaines Dr
Clinton, MO 64735
Phone (660) 885-8141

Organizations & group practices 4

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 1

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": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637020800000",
    "number": "1841212362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1602 N 2ND ST",
            "city": "CLINTON",
            "state": "MO",
            "postal_code": "647351192",
            "telephone_number": "660-885-8171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1602 N 2ND ST",
            "city": "CLINTON",
            "state": "MO",
            "postal_code": "647351192",
            "telephone_number": "660-885-8171",
            "fax_number": "660-890-8490"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "603 E Gaines Dr",
            "address_purpose": "LOCATION",
            "city": "Clinton",
            "state": "MO",
            "postal_code": "647353205",
            "country_code": "US",
            "telephone_number": "660-885-8141",
            "fax_number": "660-885-5815",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WETZEL",
        "first_name": "CARROLL",
        "middle_name": "ROBERT",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2021-11-16",
        "certification_date": "2021-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MO",
            "license": "R2H39",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "206786600",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "robwetzel@mhccaremail.com",
            "affiliation": "N",
            "address_1": "1602 N 2nd St",
            "city": "Clinton",
            "state": "MO",
            "country_code": "US",
            "postal_code": "647351192",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Clinton, MO

Sources for this page

Verify at the official NPI Registry.