Preetham Jetty, MD

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

01040154A Issued in IN

Practice address

1210 A Medical Arts Blvd
Suite 105
Anderson, IN 46011-3437

Phone

(765) 298-4660

Fax

(765) 298-4926

NPI assigned

Apr 27, 2006

Last updated

Jun 11, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• Preetham Kondlapoodi Other name

Medicare fee-for-service enrollment

Enrolled in IN

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

Specialty

Cardiovascular Disease (Cardiology)Also: Internal Medicine

Education

Other, 1979

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Community Physicians of Indiana IncGroup PAC ID 1759416662, 1,569 clinicians

Lutheran Medical Group LLCGroup PAC ID 4981751617, 251 clinicians

Community Physician Network Specialty Care LLCGroup PAC ID 9931697265, 260 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Community Hospital of Anderson and Madison County Hospital, Anderson, IN, CCN 150113
• Ascension St Vincent Mercy Hospital, Elwood, IN, CCN 151308
• Lutheran Hospital of Indiana Hospital, Fort Wayne, IN, CCN 150017
• Community Hospital East Hospital, Indianapolis, IN, CCN 150074
• Ascension St Vincent Anderson Hospital, Anderson, IN, CCN 150088

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: pjetty9268@ecommunitydirect.com

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.

• Community Physician Network Specialty Care LLC

  • Cardiovascular Disease Physician
  • Indianapolis, IN
  • NPI 1588535496
  Medicare reassignment Care Compare group NPD
• Community Physicians of Indiana Inc

  • Family Medicine Physician
  • Indianapolis, IN
  • NPI 1619105244
  Medicare reassignment Care Compare group NPD
• Lutheran Medical Group LLC

  • Cardiovascular Disease Physician
  • Fort Wayne, IN
  • NPI 1164662805
  Medicare reassignment Care Compare group NPD
• Community Physicians of Indiana Inc

  dba Community Physician Network

  • Endocrinology, Diabetes & Metabolism Physician
  • Carmel, IN
  • NPI 1992396337
  NPD
• Lutheran Medical Group LLC

  • Durable Medical Equipment & Medical Supplies
  • Fort Wayne, IN
  • NPI 1710275664
  NPD
• Orthodynamics Company, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Noblesville, IN
  • NPI 1457310492
  NPD
• Heart Partners of Indiana LLC

  • Cardiovascular Disease Physician
  • Indianapolis, IN
  • NPI 1669550588
  NPD (past)
• Indiana Heart Associates PC

  • Cardiovascular Disease Physician
  • Indianapolis, IN
  • NPI 1992821631
  NPD (past)
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Community Health Network, Inc

  • General Acute Care Hospital
  • Indianapolis, IN
  • NPI 1336119478
  Care Compare affiliation
• Community Hospital of Anderson & Madison County, Inc

  • General Acute Care Hospital
  • Anderson, IN
  • NPI 1972500452
  Care Compare affiliation
• Iom Health System LP

  dba Lutheran Hospital of Indiana

  • General Acute Care Hospital
  • Fort Wayne, IN
  • NPI 1306897335
  Care Compare affiliation
• St. Vincent Anderson Regional Hospital, Inc.

  dba Ascension St. Vincent Anderson

  • General Acute Care Hospital
  • Anderson, IN
  • NPI 1679578850
  Care Compare affiliation
• St. Vincent Madison County Health System, Inc

  dba St. Vincent Mercy Hospital

  • Critical Access Hospital
  • Elwood, IN
  • NPI 1477508596
  Care Compare affiliation

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623369600000",
    "number": "1962469510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6626 E 75TH ST",
            "address_2": "SUITE 500",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462502805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 A MEDICAL ARTS BLVD",
            "address_2": "SUITE 105",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460113437",
            "telephone_number": "765-298-4660",
            "fax_number": "765-298-4926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JETTY",
        "first_name": "PREETHAM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-27",
        "last_updated": "2021-06-11",
        "certification_date": "2021-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IN",
            "license": "01040154A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4218217",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100120660",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PTAN",
            "identifier": "P01214600",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000557249",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000586512",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PREETHAM",
            "last_name": "KONDLAPOODI",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Eunmi Wang Jeong, OTA
• Joseph G. Jerman, MD
• Jerry D Warthman, O.D., LLC
• Jetty Heart Clinic
• Jetty Heart Clinic of the Indiana Heart Hospital LLC
• Audre N Johnson, NP
• Grace Rebekah Johnson
• Greg Johnson, LSW
• Heidi Ann Johnson, MD
• Ryan Johnson

• Cardiovascular Disease Physician in Anderson, IN
• Providers in Anderson, IN by specialty
• Cardiovascular Disease Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.