Organization Active NPI

Potomac Advanced Medical Care

  • Internal Medicine Physician
  • Rockville, MD
National Provider Identifier
1770024812
Registry record updated Mar 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
D78938 Issued in MD
Legal business name
POTOMAC ADVANCED MEDICAL CARE
Practice address
2401 Research Blvd Ste 370
Rockville, MD 20850-3269
Phone
(240) 690-4114
Fax
(240) 654-3915
NPI assigned
Mar 8, 2017
Last updated
Mar 3, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2018

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

Authorized official

Name
Wei Fan, MDNPI 1013273606
Title
M.D.
Phone
(240) 690-4114

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X D78938 MD Primary

Addresses

Primary practice location

2401 Research Blvd Ste 370
Rockville, MD 20850-3269

Mailing address

2401 Research Blvd Ste 370
Rockville, MD 20850-3269
Phone (240) 690-4114

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171220000670 DC Part B Supplier - Clinic/Group Practice 6305104340 Receives reassigned benefits from 1 practitioner
Practice locations: Rockville, MD

National Provider Directory

National Provider Directory

Locations

2401 Research Blvd
Ste 300
Rockville, MD 20850
Phone (301) 762-1993

2401 Research Blvd
Ste 370
Rockville, MD 20850
Phone (240) 690-4114

Practitioners & affiliated clinicians

Practitioners 1

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": "1488931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520035200000",
    "number": "1770024812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 RESEARCH BLVD STE 370",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208503269",
            "telephone_number": "240-690-4114",
            "fax_number": "240-654-3915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 RESEARCH BLVD STE 370",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208503269",
            "telephone_number": "240-690-4114",
            "fax_number": "240-654-3915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTOMAC ADVANCED MEDICAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-08",
        "last_updated": "2018-03-03",
        "status": "A",
        "authorized_official_last_name": "FAN",
        "authorized_official_first_name": "WEI",
        "authorized_official_title_or_position": "M.D.",
        "authorized_official_telephone_number": "240-690-4114",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D78938",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2018; 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.