Individual ProviderAdam PrewittNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address100 London Mountain View Dr Fl 1, London, KY 40741-6668(859) 275-5229(502) 907-0356PECOS EnrollmentBased on the most recent information from CMS, provider Adam Prewitt is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 11:47 AM.Profile DetailsProvider ID1417589706Provider TypeIndividualFull NamePrewitt, AdamCredentialAPRNGenderMaleSole ProprietorNoEnumeration Date2/5/2020Last Updated1/19/2021Contact InformationPractice LocationPractice Address100 London Mountain View Dr Fl 1, London, KY 40741-6668Phone(859) 275-5229Fax(859) 977-2683Mailing LocationMailing Address223 Executive Park, Louisville, KY 40207Phone(502) 907-0356Fax(502) 919-9780Provider TaxonomiesCodeDescriptionLicenseCode363L00000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense3014139KentuckyProvider IdentifiersIDDescriptionIssuerID300035090DescriptionMedicaidIssuerUnlistedIndianaIDP02504366DescriptionOtherIssuerRAILROAD MEDICAREKentuckyID279842DescriptionOtherIssuerSIHO PROVIDER ID NUMBERIDCS2009900478DescriptionOtherIssuerCARESOURCE PROVIDER ID NUMBERID7100648480DescriptionMedicaidIssuerUnlistedKentuckyID000001344929DescriptionOtherIssuerANTHEM PROVIDER ID NUMBERID7326100DescriptionOtherIssuerUNITED HEALTHCARE PROVIDER ID NUMBERID2165245DescriptionOtherIssuerWELLCARE OF KENTUCKY PROVIDER ID NUMBERKentuckyIDPDZ000000438558DescriptionOtherIssuerAETNA BETTER HEALTH OF KENTUCKY PROVIDER ID NUMBERKentucky