John Thomas Yetter, M. D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

036063187 Issued in IL

Practice address

200 Health Care Dr
Ste 1501
Greenville, IL 62246-1154

Phone

(618) 664-9830

Fax

(618) 664-9820

NPI assigned

May 4, 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jerseyville Pain Management Center, S.C.

  • Chiropractor
  • Wood River, IL
  • NPI 1063470524
  NPD (past)

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1246320000000",
    "number": "1952359770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8531 FROST AVE",
            "city": "BERKELEY",
            "state": "MO",
            "postal_code": "631341443",
            "telephone_number": "314-761-1577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HEALTH CARE DR",
            "address_2": "STE 1501",
            "city": "GREENVILLE",
            "state": "IL",
            "postal_code": "622461154",
            "telephone_number": "618-664-9830",
            "fax_number": "618-664-9820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YETTER",
        "first_name": "JOHN",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "M. D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-04",
        "last_updated": "2009-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "036063187",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL  LICENSE",
            "identifier": "036363187",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE OSCAR A",
            "identifier": "810300008",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MISSOURI",
            "identifier": "841619029",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aften Wessel, FNP
• Anna White
• Lacey Wiegmann
• Amanda Wilkie, LMT
• Kalei Nguyen Wilson, DDS
• Diamond R Young, LPC
• Robert C Young, M.D.
• Amanda L Zinkgraf, CRSS, CPRS
• Todd C Zisholtz, MD

• Specialist in Greenville, IL
• Providers in Greenville, IL by specialty
• Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.