NPIMap

Organization Active NPI

Advanced Dysphagia Diagnostics LLC

  • Speech-Language Pathologist
  • Montrose, CO
National Provider Identifier
1194181206
Registry record updated Oct 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SLP.0000229 Issued in CO
Legal business name
ADVANCED DYSPHAGIA DIAGNOSTICS LLC
Practice address
611 E Star CT
Montrose, CO 81401-6704
Phone
(909) 213-5967
Fax
(509) 356-4607
NPI assigned
Jan 5, 2016
Last updated
Oct 9, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2019

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

Authorized official

Name
Kimberly A Gemmell, MS, CCC-SLP
Title
Owner
Phone
(909) 213-5967

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language PathologistGroup: 193400000X SINGLE SPECIALTY GROUP 235Z00000X SLP.0000229 CO Primary

Addresses

Primary practice location

611 E Star CT
Montrose, CO 81401-6704

Mailing address

2233 E Main St
Business Options Medical Billing
Montrose, CO 81401-3831
Phone (970) 765-0818

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160527000284 CO Part B Supplier - Clinic/Group Practice 4183914484 Receives reassigned benefits from 6 practitioners
2 other NPIs on this enrollment
Practice locations: Montrose, CO
O20171204001028 PA Part B Supplier - Clinic/Group Practice 4183914484 Receives reassigned benefits from 2 practitioners
Practice locations: Altoona, PA; Dubois, PA

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Advanced Dysphagia Diagnostics LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1451952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570579200000",
    "number": "1194181206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2233 E MAIN ST",
            "address_2": "BUSINESS OPTIONS MEDICAL BILLING",
            "city": "MONTROSE",
            "state": "CO",
            "postal_code": "814013831",
            "telephone_number": "970-765-0818",
            "fax_number": "970-497-8410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 E STAR CT",
            "city": "MONTROSE",
            "state": "CO",
            "postal_code": "814016704",
            "telephone_number": "909-213-5967",
            "fax_number": "509-356-4607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DYSPHAGIA DIAGNOSTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-05",
        "last_updated": "2019-10-09",
        "status": "A",
        "authorized_official_last_name": "GEMMELL",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-213-5967",
        "authorized_official_credential": "MS, CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "CO",
            "license": "SLP.0000229",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montrose, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2019; 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.