Advanced Gastroenterology, PLLC

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

MD00042129 Issued in WA

Legal business name

ADVANCED GASTROENTEROLOGY, PLLC

Practice address

3250 SE 164TH Ave Ste 205
Vancouver, WA 98683-9313

Phone

(360) 946-4313

Fax

(360) 576-1133

NPI assigned

Oct 31, 2006

Last updated

Nov 7, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Samuel K SimNPI 1275633844

Title

Partner

Phone

(360) 946-4313

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Samuel Sim, MD

  • Gastroenterology Physician
  • Bristol, TN
  • NPI 1275633844

  WA

  Medicare reassignment Authorized official
• Vikas Garg, MD

  • Gastroenterology Physician
  • Clackamas, OR
  • NPI 1174775951

  WA

  Medicare reassignment NPD
• Matthew French Wallace, PA-C

  • Physician Assistant
  • Vancouver, WA
  • NPI 1386091015
  Medicare reassignment
• Tulika Agarwal Malhotra, PA-C

  • Medical Physician Assistant
  • Portland, OR
  • NPI 1518319672

  WA

  Medicare reassignment
• Frank Yeh, MD

  • Gastroenterology Physician
  • Clackamas, OR
  • NPI 1710102959

  WA

  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730937600000",
    "number": "1003992090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3250 SE 164TH AVE STE 205",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986839313",
            "telephone_number": "360-946-4313",
            "fax_number": "360-314-2067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3250 SE 164TH AVE STE 205",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986839313",
            "telephone_number": "360-946-4313",
            "fax_number": "360-576-1133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED GASTROENTEROLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-31",
        "last_updated": "2024-11-07",
        "certification_date": "2024-11-07",
        "status": "A",
        "authorized_official_last_name": "SIM",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "360-946-4313"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "WA",
            "license": "MD00042129",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gastroenterology Physician in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Gastroenterology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.