Active NPI 1427026137 Individual Practitioner Male Practitioner

Dr. Keith A Micetich , MD

Specialist • Jackson, TN

Professional Overview & Biography Verified Profile Summary

Dr. Keith Micetich, MD is a registered healthcare professional specializing in Specialist in Jackson, TN. Practice services are available at 72 PHYSICIANS DR under active NPI credentials.

Frequently performed procedures and clinical services include established patient outpatient office visit, screening mammography, cervical or vaginal cancer screening; pelvic and clinical breast examination. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

72 Physicians Dr

Jackson, TN 383052070

Telephone 7316684455

Fax 7316689007

Associated Practice Facility / Clinic

🏢 Jackson Regional Womens Center Facility NPI 1235155276

Specialty Benchmarks & Practice Insights

Comparative analytics for Specialist in Jackson, TN

Active Practitioner

Practitioner Clinical Experience

Active

City Avg: 38.4 Yrs

State Avg: 36.3 Yrs

Regional Practice Density

34 Specialists

Practicing in Jackson, TN (784 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

50.1% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2023)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	76	57	$170.00	$115.91
99213 Established patient office or other outpatient visit, typically 15 minutes	59	34	$120.00	$81.96
77067 Screening mammography	41	41	$265.00	$82.11
G0101 Cervical or vaginal cancer screening; pelvic and clinical breast examination	34	34	$62.00	$35.45
Q0091 Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory	18	18	$62.00	$39.35
77063 Screening digital tomography of both breasts	11	11	$75.00	$21.37

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	86	72	$170.00	$116.89
99213 Established patient office or other outpatient visit, typically 15 minutes	73	49	$120.00	$80.78
G0101 Cervical or vaginal cancer screening; pelvic and clinical breast examination	55	55	$62.00	$36.04
77067 Screening mammography	41	41	$265.00	$83.86
Q0091 Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory	26	26	$62.00	$38.09

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	97	52	$120.00	$84.80
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	74	60	$170.00	$122.25
G0101 Cervical or vaginal cancer screening; pelvic and clinical breast examination	54	54	$62.00	$36.08
77067 Screening mammography	30	30	$265.00	$87.08
Q0091 Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory	28	28	$62.00	$39.06
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	15	15	$185.00	$126.08
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	15	15	$260.00	$159.52
77080 Dxa bone density measurement of hip, pelvis, spine	12	12	$250.00	$35.43

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	82	51	$157.02	$68.72
G0101 Cervical or vaginal cancer screening; pelvic and clinical breast examination	46	46	$73.30	$36.81
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	43	39	$240.70	$100.92
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	29	29	$152.41	$108.85
Q0091 Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory	13	13	$64.77	$39.58

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	124	58	$151.25	$69.05
G0101 Cervical or vaginal cancer screening; pelvic and clinical breast examination	63	63	$75.00	$35.92
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	33	31	$228.79	$102.04
G0438 Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit	26	26	$220.00	$160.42
Q0091 Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory	25	25	$65.00	$39.91
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	19	19	$140.00	$108.31
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	12	12	$106.00	$41.78

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	141	69	$135.00	$65.96
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	61	56	$200.00	$94.71
G0101 Cervical or vaginal cancer screening; pelvic and clinical breast examination	24	24	$75.00	$34.16
Q0091 Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory	20	20	$65.00	$39.58
G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit	12	12	$140.00	$105.86
G0438 Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit	11	11	$220.00	$156.34

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	181	88	$135.00	$64.58
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	58	54	$200.00	$93.55
G0101 Cervical or vaginal cancer screening; pelvic and clinical breast examination	32	32	$75.00	$34.37
Q0091 Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory	13	13	$55.77	$39.75
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	11	11	$285.00	$148.49
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	11	11	$200.00	$97.10

Medical Specialties & State Licenses

Specialist Primary Specialty

NUCC Taxonomy Code: 174400000X

State License TN 26274

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

Additional State Medicaid & Healthcare Payer Identifiers

Commercial Insurance / Payer ID Blue Cross Blue Shield

3009628 (TN)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

3 Associated Practitioners

Rachel Holmes , FNP-C

Nurse Practitioner - Family

NPI 1114346673

Family Nurse Practitioner (Certified)

Dr. Tayler Johnston , DNP, CNM, WHNP

Advanced Practice Midwife

NPI 1265966634

Doctor of Nursing Practice, Certified Nurse Midwife, Women's Health Nurse Practitioner

Dr. Lane Williams , MD

Obstetrics & Gynecology

NPI 1548202500

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events

✅

NPI Profile Active November 02, 2011

NPI status registered as active in NPPES database

📍

Updated Practice Location November 02, 2011

Registered at 72 PHYSICIANS DR, JACKSON, TN 383052070 (Tel: 7316684455)

📍

Updated Business Mailing Address November 02, 2011

Registered at 72 PHYSICIANS DR, JACKSON, TN 383052070 (Tel: 7316684455)

👤

Provider Name / Credentials Updated November 02, 2011

Recorded as KEITH MICETICH, MD

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) November 02, 2011

Specialist (License #26274 in TN)

🟢

Initial NPI Registration & Enumeration March 09, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1427026137

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: March 09, 2006

Last Update: November 02, 2011

Sole Proprietor: No

Update or Correct Profile

Mailing Address

72 Physicians Dr

Jackson, TN 383052070

Phone: 7316684455

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.