Provider Demographics
NPI:1154863090
Name:ADVENTIST HEALTHCARE ACO, LLC
Entity Type:Organization
Organization Name:ADVENTIST HEALTHCARE ACO, LLC
Other - Org Name:ADVENTIST MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PULIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-315-3569
Mailing Address - Street 1:820 W DIAMOND AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-1419
Mailing Address - Country:US
Mailing Address - Phone:301-315-3102
Mailing Address - Fax:
Practice Address - Street 1:820 W DIAMOND AVE
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-1419
Practice Address - Country:US
Practice Address - Phone:301-315-3030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-09
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
G02382Medicare PIN