NPIMap

Individual provider Active NPI

Rajiv Jetly, M.D.

  • Internal Medicine Physician
  • Prescott Valley, AZ
National Provider Identifier
1861494247
Registry record updated May 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
29064 Issued in AZ
Practice address
3235 N Windsong Dr
Prescott Valley, AZ 86314-1222
Phone
(928) 772-3340
Fax
(928) 759-9611
NPI assigned
Aug 15, 2005
Last updated
May 11, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 29064 AZ Primary
Infectious Disease Physician 207RI0200X 29064 AZ

Addresses

Primary practice location

3235 N Windsong Dr
Prescott Valley, AZ 86314-1222

Mailing address

PO Box 1629
Suite a
Prescott, AZ 86302-1629
Phone (928) 772-3340

Other identifiers 2

IdentifierTypeStateIssuer
555724MedicaidAZ
AZ0887390OtherAZBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20060801000298 AZ Practitioner - Internal MedicinePractitioner - Infectious Disease 3779596184 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Infectious Disease
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southwest I.D. and Medical Clinic, LCGroup PAC ID 9739192246, 2 clinicians

Practice addresses (Care Compare)

3235 N Windsong Dr
Prescott Valley, AZ 86314-1222
Phone (928) 772-3340

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
66.25 of 100Reported as group
Quality
16.67
Promoting interoperability
90
Improvement activities
40
Cost
79.18

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest I.D. & Medical Clinic, LC Infectious Disease CurrentSince Aug 22, 2006 Accepting new patients
Arizona Grand Medical Center PLLC Past Accepting new patients
Mikrut Physical Therapy LLC Past Accepting new patients

Locations

3235 N Windsong Dr
Prescott Vly, AZ 86314
Phone (928) 634-3025

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/
  • Direct secure messaging: rajivjetly@siam-az.direct.office.nextgen.com

Organizations & group practices 3

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 6

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": "1124064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494460800000",
    "number": "1861494247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1629",
            "address_2": "SUITE A",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863021629",
            "telephone_number": "928-772-3340",
            "fax_number": "928-759-9611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3235 N WINDSONG DR",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863141222",
            "telephone_number": "928-772-3340",
            "fax_number": "928-759-9611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JETLY",
        "first_name": "RAJIV",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-15",
        "last_updated": "2017-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "29064",
            "primary": true
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "AZ",
            "license": "29064",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "555724",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "AZ0887390",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Prescott Valley, AZ

Sources for this page

Verify at the official NPI Registry.