Priscilla Clinton Adams, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019031077 Issued in IL

Practice address

1121 W Michigan St
Indianapolis, IN 46202

Phone

(708) 602-0017

NPI assigned

Mar 28, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Board of Trustees of the University of Illinois

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1669493466

  IL

  Medicare reassignment NPD
• The Board of Trustees of the University of Illinois

  • Occupational Medicine Physician
  • Chicago, IL
  • NPI 1043727571
  NPD
• The Board of Trustees of the University of Illinois

  • Federally Qualified Health Center (FQHC)
  • Rockford, IL
  • NPI 1306486022
  NPD

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

{
    "created_epoch": "1459123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678320000000",
    "number": "1396107397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1616 E 56TH ST UNIT 401",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606372705",
            "telephone_number": "708-602-0017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 W MICHIGAN ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "46202",
            "telephone_number": "708-602-0017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLINTON ADAMS",
        "first_name": "PRISCILLA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-03-28",
        "last_updated": "2023-03-09",
        "certification_date": "2023-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12013039A",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019031077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "pmclinton@iupui.edu",
            "affiliation": "N",
            "address_1": "1121 W Michigan St",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "46202",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Leah Louise Clifton, PT
• Aaron Travis Cline
• Mary Katherine Cline
• Clinical Med Stats Corp
• Amina Clinker
• Brittiny Clinton
• Patrick Michael Clisham, LMFT
• Andrea M Clodfelter, PT
• Kayla Lee Clodfelter, MD
• Michelle Clodfelter, RN, BSN, FNP-C

• All providers in Indianapolis, IN
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.