NPIMap

Organization Active NPI

Ken Adolph Wellness, LLC

Doing business as Illumma

  • Anesthesiology Physician
  • Austin, TX
National Provider Identifier
1396347514
Registry record updated May 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
KEN ADOLPH WELLNESS, LLC
Doing business as
Illumma
Practice address
2911 Medical Arts St Ste 19a
Austin, TX 78705-3329
Phone
(512) 686-5935
Fax
(737) 242-9997
NPI assigned
Nov 12, 2020
Last updated
May 15, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2025

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

Authorized official

Name
Dr. Howard Kenneth Adolph, MDNPI 1215901368
Title
Founder/Medical Director
Phone
(512) 750-1348

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X NU Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU

Addresses

Primary practice location

2911 Medical Arts St Ste 19a
Austin, TX 78705-3329

Mailing address

2911 Medical Arts St Ste 19a
Austin, TX 78705-3329
Phone (512) 585-9594

Other identifiers 1

IdentifierTypeStateIssuer
1215901368MedicaidTX

Other names 1

  • Illumma Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1605139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747267200000",
    "number": "1396347514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2911 MEDICAL ARTS ST STE 19A",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787053329",
            "telephone_number": "512-585-9594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2911 MEDICAL ARTS ST STE 19A",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787053329",
            "telephone_number": "512-686-5935",
            "fax_number": "737-242-9997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEN ADOLPH WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-12",
        "last_updated": "2025-05-15",
        "certification_date": "2025-04-18",
        "status": "A",
        "authorized_official_last_name": "ADOLPH",
        "authorized_official_first_name": "HOWARD",
        "authorized_official_middle_name": "KENNETH",
        "authorized_official_title_or_position": "FOUNDER/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "512-750-1348",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1215901368",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Illumma",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Illumma",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Austin, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.