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
Organization subpart
No

Authorized official

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

Other NPIs on the same Medicare enrollment 2

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

Corporate family (same tax ID) 2

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

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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

National Provider Directory

National Provider Directory
Tax ID family
Adv Dysphagia Diag LLC (3 organizations share this tax ID)

Locations

104 S 1st St
Montrose, CO 81401
Phone (909) 213-5969

236 S 3rd St
Montrose, CO 81401
Phone (888) 599-1115

Specialties & licenses 1

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

Addresses

NPPES NPI Registry

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

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
DW7861OtherCORAILROAD WORKERS MEDICARE GROUP PTAN

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 9, 2019.

{
    "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": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD WORKERS MEDICARE GROUP PTAN",
            "identifier": "DW7861",
            "state": "CO"
        }
    ],
    "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.