Individual provider Active NPI

Adam Steven Wolf, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Port Huron, MI
National Provider Identifier
1205589728
Registry record updated Dec 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
4704278950 Issued in MI
Practice address
3111 Electric Ave
Port Huron, MI 48060-8127
Phone
(810) 985-8900
NPI assigned
Feb 3, 2022
Last updated
Dec 3, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 3, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 4704278950 MI Primary
Registered Nurse 163W00000X 4704278950 MI

Addresses

Primary practice location

3111 Electric Ave
Port Huron, MI 48060-8127

Mailing address

3111 Electric Ave
Port Huron, MI 48060-8127
Phone (810) 985-8900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251217001917 MI Practitioner - Nurse Practitioner 5698260685 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3111 Electric Ave
Port Huron, MI 48060-8127
Phone (810) 985-8900

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704278950MIMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
St Clair County Community Mental Health Authority CurrentSince Dec 1, 2025 Accepting new patients
St Clair County Community Mental Health Authority CurrentSince Dec 1, 2025 Accepting new patients

Locations

3111 Electric Ave
Port Huron, MI 48060
Phone (810) 985-4747

Organizations & group practices 2

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 1

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": "1643846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764720000000",
    "number": "1205589728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3111 ELECTRIC AVE",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480608127",
            "telephone_number": "810-985-8900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3111 ELECTRIC AVE",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480608127",
            "telephone_number": "810-985-8900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLF",
        "first_name": "ADAM",
        "middle_name": "STEVEN",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-02-03",
        "last_updated": "2025-12-03",
        "certification_date": "2025-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MI",
            "license": "4704278950",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704278950",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Huron, MI

Sources for this page

Verify at the official NPI Registry.