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

Last updated

Nov 13, 2008By 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

Dr. Matthew G PoffenrothNPI 1487645347

Title

President / Ceo

Phone

(301) 896-6900

Specialties & licenses 9

Addresses

Locations

Practitioners 58

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.

• 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": [],
    "endpoints": [],
    "other_names": []
}

• Narcedalia Pratt
• Marjorie Watters Pray, RN/NP
• Monroe Pray Jr., MD
• Precision Orthopedics and Sports Medicine
• Premier Physician Group D/B/a Suburban Audiology
• Premise Health of Maryland Medical P C (The Wellness Center Operated by Premise Health)
• 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.