Organization Active NPI

Capital Center for Functional Medicine LLC

  • Internal Medicine Physician
  • Bethesda, MD
National Provider Identifier
1922496462
Registry record updated Dec 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
D66066 Issued in MD
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

Updated by the provider on Dec 6, 2024

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)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 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

IdentifierTypeStateIssuer
014051100MedicaidMD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150520002003 DC Part B Supplier - Clinic/Group Practice 8820318520 Receives reassigned benefits from 1 practitioner
Practice locations: Bethesda, MD; Potomac, MD

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D2308143Capital Center for Functional Medicine LLC11325 Seven Locks Rd Suite 290, Potomac, MD 20854Certificate of waiverJul 22, 2028

National Provider Directory

National Provider Directory

Locations

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

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.

Verify at the official NPI Registry.