Physician Compare National (NPI:1417042714)

HEALTHCARE PROVIDER: JERRY W ADAMS MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1417042714
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1850567850
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20111221000612
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ADAMS
	Individual professional last name
Provider First Name	JERRY
	Individual professional first name
Provider Middle Name	WINSTON
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	WASHINGTON UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1977
	Individual professional's medical school graduation year
Primary Specialty	GENERAL PRACTICE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	3266 N MERIDIAN ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 708
	Group Practice or individual's line 2 address
City	INDIANAPOLIS
	Group Practice or individual's city
State	IN
	Group Practice or individual's state
Zip Code	462085846
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3179268839
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	150024
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ESKENAZI HEALTH
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	150056
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	INDIANA UNIVERSITY HEALTH METHODIST HOSPITAL (INDIANAPOLIS)
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y