Provider Demographics
NPI:1275500522
Name:ADAMS, JODY (NP)
Entity Type:Individual
Prefix:MS
First Name:JODY
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E WAYNE ST STE 510
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-2394
Mailing Address - Country:US
Mailing Address - Phone:574-334-5400
Mailing Address - Fax:574-334-5368
Practice Address - Street 1:1205 S MAIN ST
Practice Address - Street 2:SUITE 301
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307
Practice Address - Country:US
Practice Address - Phone:800-860-8100
Practice Address - Fax:219-661-0448
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000524A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000727149OtherANTHEM
IN200326670Medicaid
IN409080KMedicare PIN
INS80424Medicare UPIN
INM400054255Medicare PIN
IN197050GMedicare PIN