VICTA LLC
NPI 1104317007
Internal Medicine - Addiction Medicine in Providence, RI
NPI Status: Active since May 25, 2018
Contact Information
110 ELMWOOD AVE # A
PROVIDENCE, RI
ZIP 02907
Phone: (401) 868-0654
- Organization
- Internal Medicine
- Addiction Medicine
- Accepts Insurance
- CLIA Number: 41D2154689
- CLIA Cert. Type: Community Clinic
- CLIA Exp. Date: 09-17-2026
About VICTA LLC
This page provides the complete NPI Profile along with additional information for Victa Llc, an internist established in Providence, Rhode Island operating as a Internal Medicine, focusing in addiction medicine . The healthcare provider is registered in the NPI registry with number 1104317007 assigned on May 2018. The practitioner's primary taxonomy code is 207RA0401X. The provider is registered as an organization and their NPI record was last updated March 2026. Victa Llc operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The authorized official of this NPI record is Mr. Alexander Donoyan (Ceo)
- NPI
- 1104317007
- Provider Name
- VICTA LLC
- Entity Type
- Organization
- Location Address
- 110 ELMWOOD AVE # A PROVIDENCE, RI 02907
- Location Phone
- (401) 868-0654
- Mailing Address
- 110 ELMWOOD AVE PROVIDENCE, RI 02907
- Mailing Phone
- (401) 300-5757
- Mailing Fax
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 05-25-2018
- Last Update Date
- 03-23-2026
- Code Navigator
An internist like Victa Llc is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, etc.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Internal Medicine Addiction Medicine
- Taxonomy Code
- 207RA0401X
- Type
- Allopathic & Osteopathic Physicians
- Taxonomy Description
- 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.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | |
| 2 | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | |
| 3 | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | |
| 4 | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | |
| 5 | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | |
| 6 | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | |
| 7 | 133NN1002X | Dietary & Nutritional Service Providers | Nutritionist | |
| 8 | 163WA0400X | Nursing Service Providers | Registered Nurse | |
| 9 | 163WP2201X | Nursing Service Providers | Registered Nurse | |
| 10 | 175T00000X | Other Service Providers | Peer Specialist | |
| 11 | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | |
| 12 | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | 648.01 (RI) |
| 13 | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | 648.01 (RI) |
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- NH Local Choice HMO Bronze 8000 + $0 Rx list + $0 Virtual Urgent Care - HMO
- NH Local Choice HMO Gold + $0 Rx list + $0 Virtual Urgent Care - HMO
- NH Local Choice HMO Gold 1400 + $0 Rx list + $0 Virtual Urgent Care - HMO
- NH Local Choice HMO HSA Bronze 6000 - HMO
- NH Local Choice HMO Silver 3500 + $0 Rx list + $0 Virtual Urgent Care - HMO
- NH Local Choice HMO Silver 5000 + $0 Rx list + $0 Virtual Urgent Care - HMO
- NH Local HMO Bronze 7500 Standard + $0 Rx list + $0 Virtual Urgent Care - HMO
- NH Local HMO Gold 2000 Standard + $0 Rx list + $0 Virtual Urgent Care - HMO
- NH Local HMO Silver 6000 Standard + $0 Rx list + $0 Virtual Urgent Care - HMO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Areas of Expertise
The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.
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
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.
This service was performed 227 times for 13 patientsCLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 41D2154689
- Facility Type
- Community Clinic
- Certificate Effective Date
- September 18, 2024
- Certificate Expiration Date
- September 17, 2026
- Laboratory Director
- LISA A. PETERSON
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Victa Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1104317007, we treat the final digit (7) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 43. The final step is to find the difference between that total and the next multiple of ten (50 - 43 = 7).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 43 is 50. The difference is the calculated check digit.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1104317007, enumerated as an "organization" on May 25, 2018.
The provider is located at 110 ELMWOOD AVE # A PROVIDENCE, RI 02907 and the phone number is (401) 868-0654.
Internal Medicine with taxonomy code 207RA0401X and a focus in Addiction Medicine.
The provider might be accepting Accepts: Harvard Pilgrim Health Care. Please consult your insurance carrier or call the provider to verify.
