Provider Demographics
NPI:1992793954
Name:ADKINS, JEFFREY L (CRNA)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
Last Name:ADKINS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19248
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9248
Mailing Address - Country:US
Mailing Address - Phone:217-528-7541
Mailing Address - Fax:
Practice Address - Street 1:1025 S 6TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-2499
Practice Address - Country:US
Practice Address - Phone:217-528-7541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005185367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL695055OtherHEALTHLINK INDIVIDUAL #
IL0841504038OtherBCBS OF ILLINOIS
IL209-005185OtherIL APN LICENSE #
IL104409OtherHEALTHLINK GROUP NUMBER
IL41298313Medicaid
IL71328OtherAANA#
IL41298313Medicaid
ILP00149034Medicare ID - Type UnspecifiedMCARERR
IL794510Medicare ID - Type UnspecifiedMEDICARE GROUP #
IL104409OtherHEALTHLINK GROUP NUMBER
ILQ23884Medicare UPIN
ILK09806Medicare ID - Type UnspecifiedMEDICARE PART B