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

Last updated

Mar 9, 2023By the provider in NPPES

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Board of Trustees of the University of Illinois

  dba Uih-Mile Square Health Center

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1669493466
  Medicare reassignment NPD
• The Board of Trustees of the University of Illinois

  dba Occupational Health Service Institute (OHSI)

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

  dba UI Health Mile Square Health Center L. P. Johnson Rockford

  • 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": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019031077",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "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": []
}

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

• General Practice Dentistry in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• 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.