NPIMap

Organization Active NPI

David W. Kossoff, M.D., LLC

Doing business as Optimal Digestive Care

  • Specialist
  • Frederick, MD
National Provider Identifier
1437206984
Registry record updated May 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
D0054121 Issued in MD
Legal business name
DAVID W. KOSSOFF, M.D., LLC
Doing business as
Optimal Digestive Care
Practice address
110 Thomas Johnson Dr Ste 335
Frederick, MD 21702-4949
Phone
(301) 624-5566
Fax
(301) 624-5542
NPI assigned
Jan 5, 2007
Last updated
May 19, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2025

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

Authorized official

Name
Alan Oliver
Title
Ceo
Phone
(786) 530-3820

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X D0054121 MD Primary

Addresses

Primary practice location

110 Thomas Johnson Dr Ste 335
Frederick, MD 21702-4949

Mailing address

110 Thomas Johnson Dr Ste 335
Frederick, MD 21702-4949
Phone (301) 624-5566

Other identifiers 7

IdentifierTypeStateIssuer
133102701MedicaidMD
4040001OtherMDCAREFIRST NAT CAP AREA
P10152OtherMDINFORMED
376329OtherMDMDIPA OPT CHOICE
P00206418OtherMDRAILROAD MEDICARE
682BDAOtherMDCAREFRIST OF MD
494710OtherMDNCPPO

Other names 1

  • Optimal Digestive Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050404000940 MD Part B Supplier - Clinic/Group Practice 1850348632 Receives reassigned benefits from 11 practitioners
Practice locations: Frederick, MD

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D1037930David W Kossoff MD PA Dba Optimal Digestive Care110 Thomas Johnson Dr Ste 335, Frederick, MD 21702Certificate of waiverMar 7, 2027

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

70 Thomas Johnson Dr
Frederick, MD 21702
Phone (301) 624-5566

Practitioners & affiliated clinicians

Practitioners 11

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": "1167955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747612800000",
    "number": "1437206984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 THOMAS JOHNSON DR STE 335",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217024949",
            "telephone_number": "301-624-5566",
            "fax_number": "301-624-5542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 THOMAS JOHNSON DR STE 335",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217024949",
            "telephone_number": "301-624-5566",
            "fax_number": "301-624-5542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID W. KOSSOFF, M.D., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-05",
        "last_updated": "2025-05-19",
        "certification_date": "2025-05-19",
        "status": "A",
        "authorized_official_last_name": "OLIVER",
        "authorized_official_first_name": "ALAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "786-530-3820"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MD",
            "license": "D0054121",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "133102701",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST NAT CAP AREA",
            "identifier": "4040001",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INFORMED",
            "identifier": "P10152",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MDIPA OPT CHOICE",
            "identifier": "376329",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00206418",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFRIST OF MD",
            "identifier": "682BDA",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPPO",
            "identifier": "494710",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optimal Digestive Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Optimal Digestive Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Frederick, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.