Michael Dean Adams, M.D.
Individual provider Active NPI Family Medicine Physician · Evanston, WY
NPI 1922005347 · NPPES record last updated Jun 13, 2019
Key facts
- NPI
- 1922005347
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 4371-A (WY)
- Practice address
- 75 Yellow Creek Rd
Suite 102
Evanston, WY 82930-5235 - Phone
- (307) 789-8290
- Fax
- (307) 789-8975
- NPI assigned
- Jun 30, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in UT, WY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110823000128 | UT | Practitioner - Family Practice | 2860474368 | Reassigns benefits to 1 organization |
| I20111110000249 | WY | Practitioner - Family Practice | 2860474368 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 181920-8905 | UT | MD | Family Medicine Physician |
| 4371-A | WY | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Michael D. Adams, M.D., P.C. | Family Medicine | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 181920-8905 | UT | |
| Family Medicine Physician | 207Q00000X | 4371-A | WY | Yes |
Addresses
Primary practice location
75 Yellow Creek Rd
Suite 102
Evanston, WY 82930-5235
Mailing address
75 Yellow Creek Rd
Suite 102
Evanston, WY 82930-5235
Phone (307) 789-8290
Other practice location 1
1515 N 400 E Ste 104
North Logan, UT 84341-7595
Phone (435) 755-6061
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 53D0977203 | Other | WY | CLIA NUMBER |
| 0004116106 | Other | AETNA | |
| 080014492 | Other | RAILROAD MEDICARE | |
| 103977600 | Medicaid | WY | |
| C12604 | Other | UPIN | |
| 02902001 | Other | WY | BLUECROSS/BLUESHIELD CLIN |
Other providers in Evanston, WY
- Accessible Rehabilitation Management Service, Inc.
- Accessible Rehabilitation Management Services, Inc.
- Marie A Adams
- Belinda Adolfsen
- Advanced Practice Psychiatric Services, LLC
- Taylor Allen
- Evelyn Lee Allred
- Kathryn Anderson
All providers in Evanston, WY · Family Medicine Physician in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 13, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.