Individual provider Active NPI

Jeffery R Adams, MD

  • Otolaryngology Physician
  • Everett, WA
National Provider Identifier
1104891175
Registry record updated Dec 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
MD00039990 Issued in WA
Practice address
3927 Rucker Ave
Everett, WA 98201-4833
Phone
(425) 339-5441
NPI assigned
Feb 22, 2006
Last updated
Dec 6, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X MD00039990 WA Primary

Addresses

Primary practice location

3927 Rucker Ave
Everett, WA 98201-4833

Mailing address

PO Box 5127
Everett, WA 98206-5127
Phone (425) 258-3900

Other identifiers 1

IdentifierTypeStateIssuer
1002536MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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

Enrollment IDStateProvider typePAC IDDetails
I20100929000953 WA Practitioner - Otolaryngology 4183740954 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
University of Washington School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Optum Care Washington PLLCGroup PAC ID 6406752153, 684 clinicians

Practice addresses (Care Compare)

3927 Rucker Ave
Everett, WA 98201-4833
Phone (425) 339-3930

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Care Washington PLLC CurrentSince Sep 1, 2001 Accepting new patients
Optum Care Washington PLLC CurrentSince Sep 1, 2001 Accepting new patients
Optum Care Washington PLLC Past Accepting new patients

Locations

21401 72nd Ave W
Edmonds, WA 98026
Phone (425) 304-1101

1330 Rockefeller Ave
Everett, WA 98201
Phone (425) 258-3903

3927 Rucker Ave
Everett, WA 98201
Phone (425) 339-5419

3927 Rucker Ave
Bldg Ksc
Everett, WA 98201

1201 N 175th St
Shoreline, WA 98133
Phone (425) 339-4299

Interoperability endpoints

  • Direct secure messaging: jadams1334@direct.tecmc.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 2

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": "1140566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480982400000",
    "number": "1104891175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5127",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982065127",
            "telephone_number": "425-258-3900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3927 RUCKER AVE",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982014833",
            "telephone_number": "425-339-5441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADAMS",
        "first_name": "JEFFERY",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-22",
        "last_updated": "2016-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "WA",
            "license": "MD00039990",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1002536",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Everett, WA

Sources for this page

Verify at the official NPI Registry.