NPIMap

Organization Active NPI

Advanced Gi Associates LLC

  • Gastroenterology Physician
  • North Bethesda, MD
National Provider Identifier
1770810038
Registry record updated Nov 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
D0058186 Issued in MD
Legal business name
ADVANCED GI ASSOCIATES LLC
Practice address
10846 Antigua Ter
#203
North Bethesda, MD 20852-5532
Phone
(301) 770-5711
NPI assigned
Nov 6, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2009

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

Authorized official

Name
Dr. Homayoon Mahjoob, M.D.NPI 1740494178
Title
Sole MBR
Phone
(301) 770-5711

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
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X D0058186 MD Primary

Addresses

Primary practice location

10846 Antigua Ter
#203
North Bethesda, MD 20852-5532

Mailing address

10846 Antigua Ter
#203
North Bethesda, MD 20852-5532
Phone (301) 770-5711

Other names 1

  • ADVANCED GASTROENTEROLOGY ASSOCIATES LLC Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100305000488 DC Part B Supplier - Clinic/Group Practice 9537204235 Receives reassigned benefits from 1 practitioner
Practice locations: Glenn Dale, MD

National Provider Directory

National Provider Directory

Locations

12150 Annapolis Rd
Ste 312
Glenn Dale, MD 20769
Phone (301) 352-7771

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1257465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257465600000",
    "number": "1770810038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10846 ANTIGUA TER",
            "address_2": "#203",
            "city": "NORTH BETHESDA",
            "state": "MD",
            "postal_code": "208525532",
            "telephone_number": "301-770-5711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10846 ANTIGUA TER",
            "address_2": "#203",
            "city": "NORTH BETHESDA",
            "state": "MD",
            "postal_code": "208525532",
            "telephone_number": "301-770-5711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED GI ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-06",
        "last_updated": "2009-11-06",
        "status": "A",
        "authorized_official_last_name": "MAHJOOB",
        "authorized_official_first_name": "HOMAYOON",
        "authorized_official_title_or_position": "SOLE MBR",
        "authorized_official_telephone_number": "301-770-5711",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MD",
            "license": "D0058186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ADVANCED GASTROENTEROLOGY ASSOCIATES LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in North Bethesda, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2009; 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.