Individual provider Active NPI

Adam Jon Williams, D.C.

  • Chiropractor
  • Clemmons, NC
National Provider Identifier
1972583862
Registry record updated Jan 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3276 Issued in NC
Practice address
2575 Old Glory Rd Ste 300
Clemmons, NC 27012-9585
Phone
(336) 712-4100
Fax
(336) 712-4144
NPI assigned
Jan 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3276 NC Primary

Addresses

Primary practice location

2575 Old Glory Rd Ste 300
Clemmons, NC 27012-9585

Mailing address

2575 Old Glory Rd Ste 300
Clemmons, NC 27012-9585
Phone (336) 712-4100

Other identifiers 2

IdentifierTypeStateIssuer
085VROtherNCBLUE CROSS BLUE SHIELD
5901160MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050512000729 NC Practitioner - Chiropractic 8224097076 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Optimal Health Chiropractic PLLCGroup PAC ID 0244361368, 2 clinicians

Practice addresses (Care Compare)

2575 Old Glory Rd
Suite 300
Clemmons, NC 27012-9585
Phone (336) 712-4100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3276NCMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Optimal Health Chiropractic Chiropractor CurrentSince Aug 11, 2019 Accepting new patients
Optimal Health Chiropractic PLLC Chiropractor CurrentSince Apr 7, 2005 Accepting new patients
Okemos Family Chiropractic Inc Chiropractor PastSince Jan 8, 2013 Accepting new patients

Locations

2575 Old Glory Rd
Ste 400
Clemmons, NC 27012

2575 Old Glory Rd
Ste 300
Clemmons, NC 27012
Phone (336) 712-4100

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579478400000",
    "number": "1972583862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2575 OLD GLORY RD STE 300",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270129585",
            "telephone_number": "336-712-4100",
            "fax_number": "336-712-4144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2575 OLD GLORY RD STE 300",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270129585",
            "telephone_number": "336-712-4100",
            "fax_number": "336-712-4144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "ADAM",
        "middle_name": "JON",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-18",
        "last_updated": "2020-01-20",
        "certification_date": "2020-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "3276",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "085VR",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5901160",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clemmons, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.