Advanced Digestive Care, LLC

Primary specialty

Clinical Pathology/Laboratory Medicine PhysicianTaxonomy code 207ZP0105X

Legal business name

ADVANCED DIGESTIVE CARE, LLC

Practice address

3301 Woodburn Rd Ste 107
Annandale, VA 22003-1297

Phone

(703) 876-0437

Fax

(703) 876-0722

NPI assigned

Mar 23, 2015

Last updated

Jun 5, 2023By 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

Martin G Prosky, MDNPI 1740215391

Title

Administrator

Phone

(703) 407-7216

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

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.

• Martin G Prosky, M.D.

  • Gastroenterology Physician
  • Annandale, VA
  • NPI 1740215391

  DC

  Medicare reassignment Care Compare group NPD Authorized official
• Srikrishna Vemana, M.D.

  • Gastroenterology Physician
  • Annandale, VA
  • NPI 1578771820

  DC

  Medicare reassignment Care Compare group NPD
• Amy Peng, FNP

  • Family Nurse Practitioner
  • Reston, VA
  • NPI 1457926222

  DC

  Medicare reassignment NPD
• Katie Crain Zimmerman, CRNP

  • Family Nurse Practitioner
  • Annandale, VA
  • NPI 1639154099

  DC

  Medicare reassignment NPD
• Monica Buzzetta, PA-C

  • Medical Physician Assistant
  • Annandale, VA
  • NPI 1508986100

  DC

  Medicare reassignment

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

{
    "created_epoch": "1427068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685923200000",
    "number": "1629462171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3301 WOODBURN RD STE 107",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "220031297",
            "telephone_number": "703-876-0437",
            "fax_number": "703-876-0722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3301 WOODBURN RD STE 107",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "220031297",
            "telephone_number": "703-876-0437",
            "fax_number": "703-876-0722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DIGESTIVE CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-23",
        "last_updated": "2023-06-05",
        "certification_date": "2023-06-05",
        "status": "A",
        "authorized_official_last_name": "PROSKY",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "703-407-7216",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0105X",
            "taxonomy_group": "",
            "desc": "Pathology, Clinical Pathology/Laboratory Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Pathology/Laboratory Medicine Physician in Annandale, VA
• Providers in Annandale, VA by specialty
• Clinical Pathology/Laboratory Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2023; 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.