Active NPI
Capital Center for Functional Medicine LLC
- Internal Medicine Physician
- Bethesda, MD
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- D66066
- Legal business name
- CAPITAL CENTER FOR FUNCTIONAL MEDICINE LLC
- Practice address
- 4701 Sangamore Rd Ste N270
Bethesda, MD 20816-2528 - Phone
- (240) 507-5110
- NPI assigned
- Jan 7, 2015
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Andrew Wong, MD
- Title
- Founder and Medical Director
- Phone
- (301) 892-2658
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | D66066 | MD | Primary |
Addresses
Primary practice location
4701 Sangamore Rd Ste N270
Bethesda, MD 20816-2528
Mailing address
416 Green Pasture Dr
Rockville, MD 20852-4233
Phone (301) 892-2658
Other practice location 1
11325 Seven Locks Rd Ste N290
Potomac, MD 20854-3205
Phone (240) 507-5110
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 014051100 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC
Enrollment records 1
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 21D2308143 | Capital Center for Functional Medicine LLC | Certificate of waiver | Jul 22, 2028 |
National Provider Directory
National Provider DirectoryLocations
4701 Sangamore Rd
Ste N270
Bethesda, MD 20816
Phone (240) 507-5110
11325 Seven Locks Rd
Ste N290
Potomac, MD 20854
Phone (240) 507-5110
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": "1420588800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1733443200000",
"number": "1922496462",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "416 GREEN PASTURE DR",
"city": "ROCKVILLE",
"state": "MD",
"postal_code": "208524233",
"telephone_number": "301-892-2658"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4701 SANGAMORE RD STE N270",
"city": "BETHESDA",
"state": "MD",
"postal_code": "208162528",
"telephone_number": "240-507-5110"
}
],
"practiceLocations": [
{
"address_1": "11325 Seven Locks Rd Ste N290",
"address_purpose": "LOCATION",
"city": "Potomac",
"state": "MD",
"postal_code": "208543205",
"country_code": "US",
"telephone_number": "240-507-5110",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "CAPITAL CENTER FOR FUNCTIONAL MEDICINE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2015-01-07",
"last_updated": "2024-12-06",
"certification_date": "2024-12-06",
"status": "A",
"authorized_official_last_name": "WONG",
"authorized_official_first_name": "ANDREW",
"authorized_official_title_or_position": "FOUNDER AND MEDICAL DIRECTOR",
"authorized_official_telephone_number": "301-892-2658",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": "MD",
"license": "D66066",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "014051100",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Bethesda, MD
- Melinda Capaldi, PSYD
- Vincent Florento Capaldi II, SC.M., M.D.
- Capital Cardiovascular & Thoracic Surgery Associates, PLLC
- Capital Care Anesthesia LLC
- Capital Center for Acupuncture & Integrative Medicine, LLC
- Capital Compounding, Inc.
- Capital Eye Care LLC
- Capital Health Managers, LLC
- Capital Healthcare PC
- Capital Home Care Services LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.