Premier Physician Group, LLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

PREMIER PHYSICIAN GROUP, LLC

Practice address

6430 Rockledge Drive
Suite 470
Bethesda, MD 20817

Phone

(301) 896-6931

Fax

(301) 581-0077

NPI assigned

Feb 13, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Matthew G PoffenrothNPI 1487645347

Title

President / Ceo

Phone

(301) 896-6900

Specialties & licenses 9

Addresses

Other identifiers 1

Locations

Practitioners 58

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

• Matthew G Poffenroth, MD

  • Internal Medicine Physician
  • Eldersburg, MD
  • NPI 1487645347
  NPD (past) Authorized official
• Katherine L Alley, MD

  • Surgery Physician
  • Bethesda, MD
  • NPI 1811916158
  NPD (past)
• Eric R Brodsky, MD

  • Internal Medicine Physician
  • Bethesda, MD
  • NPI 1235120056
  NPD (past)
• Andrea Danielle Burmeister, PA

  • Medical Physician Assistant
  • Bethesda, MD
  • NPI 1053559880
  NPD (past)
• George Lee Coppit III, MD

  • Otolaryngology Physician
  • Annapolis, MD
  • NPI 1760581821
  NPD (past)
• Enrique Daza Racines, M.D.

  • Surgery Physician
  • Bethesda, MD
  • NPI 1649229634
  NPD (past)
• Veronica Ann Difresco, MD

  • Internal Medicine Physician
  • Rockville, MD
  • NPI 1659376184
  NPD (past)
• Joseph R Fontana, MD

  • Critical Care Medicine (Internal Medicine) Physician
  • Bethesda, MD
  • NPI 1679521223
  NPD (past)
• Roy Fried, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Bethesda, MD
  • NPI 1881626059
  NPD (past)
• Natasha P Haag, MD

  • Internal Medicine Physician
  • Bethesda, MD
  • NPI 1417948399
  NPD (past)
• Theo Heller, MD

  • Gastroenterology Physician
  • Bethesda, MD
  • NPI 1457342305

  Internal Medicine

  NPD (past)
• Patricia Deal Kellogg, MD

  • Internal Medicine Physician
  • Rockville, MD
  • NPI 1235134701
  NPD (past)

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

{
    "created_epoch": "1202860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226534400000",
    "number": "1801064704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 791372",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212791372",
            "telephone_number": "301-896-6931",
            "fax_number": "301-581-0077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6430 ROCKLEDGE DRIVE",
            "address_2": "SUITE 470",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "20817",
            "telephone_number": "301-896-6931",
            "fax_number": "301-581-0077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER PHYSICIAN GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-13",
        "last_updated": "2008-11-13",
        "status": "A",
        "authorized_official_last_name": "POFFENROTH",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT / CEO",
        "authorized_official_telephone_number": "301-896-6900",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Colon & Rectal Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Audiologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "415096100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dayon Pratt
• Narcedalia Pratt
• Marjorie Watters Pray, RN/NP
• Monroe Pray Jr., MD
• Premier Physician Group D/B/a Suburban Audiology
• Premise Health of Maryland Medical P C
• Vincent J Prestipino, D.D.S.
• Ryan Kelburne Preston, M.D.
• Emily R Preuss, LMSW
• Melissa Michelle Previl

• Surgery Physician in Bethesda, MD
• Providers in Bethesda, MD by specialty
• Surgery Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.