DR. THOMAS JETMORE (M.D.) – Otolaryngology Physician, NPI 1104274463
Otolaryngology Physician
Main info
Doctor Profile
Contacts
Profile Insights
NPPES metrics only — not quality of care.
428 OTOLARYNGOLOGY in MI
Provider Addresses for DR. THOMAS JETMORE (M.D.)
4201 SAINT ANTOINE ST # UHC
WSU DEPARTMENT OF OTOLARYNGOLOGY
DETROIT, MI 482012153
Phone:
Type: Mailing
1434 CHESTER BLVD
RICHMOND, IN 473741947
Phone: (765) 966-1600
Fax: (765) 962-9641
Type: Location
1100 REID PKWY
RICHMOND, IN 473741157
Phone: (765) 966-1600
Fax: (765) 962-9641
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 43 Open Payments records for all available years, with a total value of $1,821.
Total Amount is formed as General ($1,821) + Research ($0) + Ownership ($0) = $1,821.
Last reported payment date: 2024-12-10 • Largest payer in this snapshot: Smith+Nephew, Inc. ($914).
Total Amount
$1,821
General + Research + Ownership
Payments
43
Total payment records
General Amount
$1,821
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-10
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Smith+Nephew, Inc. | $914 |
| Inspire Medical Systems, Inc. | $647 |
| Stryker Corporation | $261 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2021-06-29
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20210629002958 | I | Otolaryngology | IN | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 208 | 170 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 202 | 151 | $0 |
| 69210 | Removal of impacted ear wax | 186 | 147 | $0 |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 160 | 160 | $0 |
| 99203 | New patient office or other outpatient visit, 30-44 minutes | 115 | 115 | $0 |
Insurance plans in this area (ZIP 48201)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | OK | |
| Internal Medicine | IN | |
| Family Practice | IN | |
| - | NC | |
| - | IN | |
| P S Y C H I A T R Y | OH | |
| Nurse Practitioner | IN | |
| - | GA | |
| Nurse Practitioner | IN | |
| - | IN |
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