Individual provider Active NPI

Adena Marie Hicks, M.D.

  • Family Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1164957049
Registry record updated Sep 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A161509 Issued in CA
Practice address
1731 E 120TH St
Los Angeles, CA 90059-3051
Phone
(323) 783-1338
NPI assigned
Apr 27, 2017
Last updated
Sep 21, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Family Medicine Physician 207Q00000X A161509 CA Primary

Addresses

Primary practice location

1731 E 120TH St
Los Angeles, CA 90059-3051

Mailing address

1731 E 120TH St
Los Angeles, CA 90059-3051

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20231005003857 GA Practitioner - Family Practice 6709218308 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Human Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medcura Health, IncGroup PAC ID 2961443643, 15 clinicians

Practice addresses (Care Compare)

1760 Candler Rd
Decatur, GA 30032-3254
Phone (404) 298-7658

5582 Memorial Centers Inc
Stone Mountain, GA 30083
Phone (404) 298-7658

5910 Hillandale Dr
Suite 102
Lithonia, GA 30058-1877
Phone (404) 298-8998

770 Village Square Dr
Stone Mountain, GA 30083-3215

770 Village Square Dr
Stone Mountain, GA 30083-3380
Phone (404) 298-7658

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A161509CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
American Current Care P.a. CurrentSince Sep 30, 2024 Accepting new patients
Medcura Health, Inc. CurrentSince Jul 5, 2023 Accepting new patients
American Current Care PA CurrentSince Sep 30, 2024 Accepting new patients
Medcura Health, Inc. CurrentSince Jul 5, 2023 Accepting new patients
Medcura Health, Inc. Past Accepting new patients
Medcura Health, Inc. Past Accepting new patients

Locations

688 Spring St NW
Atlanta, GA 30308
Phone (404) 881-1155

5910 Hillandale Dr
Ste 102
Lithonia, GA 30058
Phone (770) 981-9011

220 Cobb Pkwy N
Ste 400
Marietta, GA 30062
Phone (770) 424-7125

5582 Memorial Dr
Stone Mountain, GA 30083
Phone (404) 298-7658

770 Village Square Dr
Stone Mtn, GA 30083
Phone (404) 298-7658

Interoperability endpoints

  • Direct secure messaging: adena.hicks.1@9679.direct.athenahealth.com

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1493251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600646400000",
    "number": "1164957049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1731 E 120TH ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900593051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1731 E 120TH ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900593051",
            "telephone_number": "323-783-1338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKS",
        "first_name": "ADENA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-27",
        "last_updated": "2020-09-21",
        "certification_date": "2020-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A161509",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.