1. Home
  2. Directory
  3. Rhode Island
  4. Providence
  5. Internal Medicine
  6. NPI Profile

VICTA LLC
NPI 1104317007
Internal Medicine - Addiction Medicine in Providence, RI

Active since May 25, 2018CLIA Certified · 2 labs
110 ELMWOOD AVE # A, PROVIDENCE, RI 02907(401) 868-0654 Get Directions Write a Review

NPPES record last updated: June 8, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Mar 23, 2026, Dec 10, 2025, Feb 21, 2019 and 2 more (5 updates tracked since 2018).

About Victa Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

VICTA LLC (NPI 1104317007) is a healthcare organization registered as an addiction medicine in Providence, Rhode Island and active in the NPI registry since May 2018. The organization holds 2 active CLIA laboratory certificates and lists Alexander Donoyan, Ceo, as its authorized official.

NPPES Registry Identity

NPI1104317007
Entity TypeOrganization
Primary Taxonomy207RA0401X
Legal Business NameVICTA LLC
Location Address110 ELMWOOD AVE # AProvidence, RI 02907
Mailing Address110 Elmwood AveProvidence, RI 02907-2423 · (401) 300-5757 · Fax (401) 300-5656
Phone(401) 868-0654
Organization SubpartNo
Authorized OfficialAlexander DonoyanCeo · (401) 300-5757
Enumeration DateMay 25, 2018
Last NPPES UpdateJune 8, 20265 updates tracked since enumeration
NPPES CertifiedJune 8, 2026
✔ NPI 1104317007 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 14

★ Primary SpecialtyInternal Medicine · Addiction MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207RA0401X
Definition
An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine.
Also ListedCounselorTaxonomy 101Y00000X
Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X
Also ListedCounselor · Mental HealthTaxonomy 101YM0800X
Also ListedPsychologist · Addiction (Substance Use Disorder)Taxonomy 103TA0400X
Also ListedPsychologist · CounselingTaxonomy 103TC1900X
Also ListedMarriage & Family TherapistTaxonomy 106H00000X
Also ListedRegistered Nurse · Addiction (Substance Use Disorder)Taxonomy 163WA0400X
Also ListedRegistered Nurse · Ambulatory CareTaxonomy 163WP2201X
Also ListedCommunity Health WorkerTaxonomy 172V00000X
Also ListedPeer SpecialistTaxonomy 175T00000X
Also ListedInternal Medicine · Infectious DiseaseTaxonomy 207RI0200X
Also ListedClinic/Center · Mental Health (Including Community Mental Health Center)Taxonomy 261QM0801X · License 648.01 (RI)
Also ListedClinic/Center · Rehabilitation, Substance Use DisorderTaxonomy 261QR0405X · License 648.01 (RI)
110 ELMWOOD AVE # A, Providence, RI 02907
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Harvard Pilgrim Health Care.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Victa Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

8

Medicare enrollment records show 8 clinicians reassign Medicare billing to Victa LLC, which bills Medicare for the services they deliver. Of these, 4 practice at this address and 5 within 10 miles. They are listed nearest first.

Clinicians, nearest first (8)

Yahenys Benoit, APRN
Nurse Practitioner
NPI 1669219432
110 ELMWOOD AVE
Providence, RI 02907
(401) 300-5757
✔ PECOS✔ Accepts MedicareSame address
Cheryl Brodsky, M.D.
Obstetrics/Gynecology
NPI 1376523829
110 ELMWOOD AVE
Providence, RI 02907
(401) 300-5757
✔ PECOS✔ Accepts MedicareSame address
Lisa Peterson, LMHC LCDP LCDCS MAC
Mental Health Counselor
NPI 1962514869
110 ELMWOOD AVE
Providence, RI 02907
(401) 432-6029
✔ PECOS✔ Accepts MedicareSame address
Lisa Rodrigues, FNP-BC
Nurse Practitioner
NPI 1639454572
110 ELMWOOD AVE
Providence, RI 02907
(401) 300-5757
✔ PECOS✔ Accepts MedicareSame address
Matthew Perry, MD
Family Practice
NPI 1962965905
228 BROAD ST FL 1
Providence, RI 02903
(401) 861-2403
✔ PECOS✔ Accepts Medicare0.5 mi
Karen Mcdonald, PCNS
Certified Clinical Nurse Specialist (CNS)
NPI 1841236718
1351 S COUNTY TRL BUILDING 2 SUITE 210
East Greenwich, RI 02818
(401) 884-2008
✔ PECOS11 mi
Jeremy Thayer, LICSW
Clinical Social Worker
NPI 1518094846
426 SCRABBLETOWN RD
North Kingstown, RI 02852
(401) 829-3355
✔ PECOS16 mi
Michael Weaver, M.D.
General Surgery
NPI 1215995097
553 KINGSTOWN RD
Wakefield, RI 02879
(401) 304-9111
✔ PECOS26 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 41D2154689

Victa, LLC · Providence, RI
Active · expires Sep 17, 2028
CLIA Number41D2154689
Laboratory TypeCommunity Clinic
Certificate Effective DateSeptember 18, 2026
Certificate Expiration DateSeptember 17, 2028
Laboratory DirectorLisa A. Peterson
Laboratory Phone(401) 300-5757
Laboratory LocationVicta, LLC110 Elmwood Ave, Providence, RI 02907
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 41D2321066

Victa, LLC · Providence, RI
Active · expires Mar 27, 2027
CLIA Number41D2321066
Laboratory TypeCommunity Clinic
Certificate Effective DateMarch 28, 2025
Certificate Expiration DateMarch 27, 2027
Laboratory DirectorLisa A. Peterson
Laboratory Phone(401) 300-5757
Laboratory LocationVicta, LLC45 Willard Ave Ste 2, Providence, RI 02905
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Medication assisted treatment, buprenorphine (oral); weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opi G2068
Medication Assisted Treatment (MAT) is a comprehensive approach to managing opioid addiction. It includes a weekly program of buprenorphine medication, personal and group therapy, substance use counseling, and, if necessary, toxicology testing. This service is provided by a Medicare-enrolled opioid treatment provider.
325 services13 patients

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Victa LLC's NPI number?

The NPI number for Victa LLC is 1104317007. It was assigned to this organization in the NPPES registry on May 25, 2018.

Where is Victa LLC located?

Victa LLC is located at 110 Elmwood Ave # A, Providence, RI 02907. The listed phone number is (401) 868-0654.

What is Victa LLC's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Addiction Medicine, with taxonomy code 207RA0401X.

Is Victa LLC enrolled in Medicare?

Yes. Victa LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Victa LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 8 clinicians reassign their Medicare billing to Victa LLC, in Certified Clinical Nurse Specialist (CNS), Clinical Social Worker, Family Practice, General Surgery, Mental Health Counselor and 2 other specialties. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 4 practice at this address and 5 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Victa LLC hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Victa LLC accept?

Health plans from Harvard Pilgrim Health Care list Victa LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Victa LLC was last updated on June 8, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.