Provider Demographics
NPI:1760470587
Name:ADAMS, JESSE E III (MD)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:E
Last Name:ADAMS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 COMMERCE CROSSINGS DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-2182
Mailing Address - Country:US
Mailing Address - Phone:502-253-4924
Mailing Address - Fax:502-489-5750
Practice Address - Street 1:3900 KRESGE WAY
Practice Address - Street 2:SUITE 60
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4660
Practice Address - Country:US
Practice Address - Phone:502-893-7710
Practice Address - Fax:502-893-1884
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044036A207RC0000X
KY31496207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200047430Medicaid
KY64314966Medicaid
KY060057273OtherRAILROAD MEDICARE
KY060033054OtherRAILROAD MEDICARE
KY0690815Medicare PIN
KY0640901Medicare PIN
KY1273214Medicare PIN
IN228550VMedicare PIN
KY00312002Medicare PIN
KY060057273OtherRAILROAD MEDICARE
KY00546052Medicare Oscar/Certification
KY00308002Medicare PIN
IN126930KMedicare PIN
KY00311002Medicare PIN
KY00314002Medicare PIN
IN228550OMedicare PIN
KY0245410Medicare PIN
KY1600111Medicare PIN
IN200047430Medicaid
KY00310002Medicare PIN
KY0955501Medicare PIN
KYP00612943Medicare PIN
IN251440LMedicare PIN
KY00313002Medicare PIN