Kenneth B Adams, PHYSICIAN ASSISTANT

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2020040966 Issued in MO

Practice address

621 S New Ballas Rd Ste 3005B
Saint Louis, MO 63141-8266

Phone

(314) 567-5850

NPI assigned

Oct 4, 2017

Last updated

May 26, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kadams393713@direct-ehr-ssmhc.com
• Direct secure messaging: kenneth.adams@9795.chartlogic.direct-ci.com

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.

• Cep America LLC

  • Emergency Medicine Physician
  • Wentzville, MO
  • NPI 1568017994
  NPD
• Cep America LLC

  • Emergency Medicine Physician
  • Fort Lauderdale, FL
  • NPI 1700747946
  NPD
• Munster Medical Research Foundation, Inc.

  dba Community Surgery Center Pharmacy

  • Community/Retail Pharmacy
  • Munster, IN
  • NPI 1235209826
  NPD (past)

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

{
    "created_epoch": "1507075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621987200000",
    "number": "1851801823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 S BALLAS RD STE 3005B",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631225314",
            "telephone_number": "314-567-5850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 S NEW BALLAS RD STE 3005B",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418266",
            "telephone_number": "314-567-5850"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6375 US Highway 64",
            "address_2": "Ste D",
            "address_purpose": "LOCATION",
            "city": "Portage",
            "state": "IN",
            "postal_code": "463685218",
            "country_code": "US",
            "telephone_number": "219-945-4488",
            "fax_number": "219-703-6702",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "801 MacArthur Blvd Ste 301",
            "address_purpose": "LOCATION",
            "city": "Munster",
            "state": "IN",
            "postal_code": "463212920",
            "country_code": "US",
            "telephone_number": "219-836-1060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ADAMS",
        "first_name": "KENNETH",
        "middle_name": "B",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-04",
        "last_updated": "2021-05-26",
        "certification_date": "2021-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2020040966",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10002325A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300011444",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kenneth.adams2@mercy.net",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "621 S New Ballas Rd Ste 3005B",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631418266",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Hannah Grace Adams, MD
• Helen Louise Adams, AGNP
• Joshua Hollis Adams
• Julie Adams, D.O.
• Kamilah Rashi Adams, RN
• Leslie Helena Adams
• Lindsay Adams
• Lucas Adams, MD
• Madeline Marie Adams, LCSW
• Mandy Adams

• Physician Assistant in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Physician Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2021; 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.