Active NPI
Kenneth Adams, PA-C
- Medical Physician Assistant
- Chillicothe, IL
National Provider Identifier
1255351276
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 036071354
- Practice address
- 525 Sweetbriar Dr
Chillicothe, IL 61523 - Phone
- (309) 274-2102
- NPI assigned
- Jul 20, 2006
- Last updated
- Oct 29, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 036071354 | IL | Primary |
Addresses
Primary practice location
525 Sweetbriar Dr
Chillicothe, IL 61523
Mailing address
5100 Reliable Pkwy
Chicago, IL 60686-0001
Phone (309) 672-4240
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 008863 | Other | IL | HEALTH ALLIANCE |
| 970016346 | Other | IL | MEDICARE RAILROAD |
| IL01R7 | Other | IL | JOHN DEERE |
| 472299 | Other | IL | HEALTHLINK |
| 0360713543 | Medicaid | IL | |
| 7215059 | Other | IL | BCBS PPO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036071354 | IL | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Methodist Medical Center of Illinois | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba Methodist Medical Group
- Family Medicine Physician
- Peoria, IL
- NPI 1184670663
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1256774400000",
"number": "1255351276",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5100 RELIABLE PKWY",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606860001",
"telephone_number": "309-672-4240"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "525 SWEETBRIAR DR",
"city": "CHILLICOTHE",
"state": "IL",
"postal_code": "61523",
"telephone_number": "309-274-2102"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ADAMS",
"first_name": "KENNETH",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-20",
"last_updated": "2009-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "IL",
"license": "036071354",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH ALLIANCE",
"identifier": "008863",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "970016346",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "JOHN DEERE",
"identifier": "IL01R7",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK",
"identifier": "472299",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0360713543",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PPO",
"identifier": "7215059",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chillicothe, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.