VICTA LLC
VICTA LLC is an organization registered with the National Plan and Provider Enumeration System (NPPES) under NPI 1104317007, based in Providence, RI. The organization lists 14 taxonomy classifications, with Addiction Medicine (Internal Medicine) Physician recorded as primary.
Getting there
The practice address on file is 110 ELMWOOD AVE # A, Providence, RI 02907. We have not yet mapped what surrounds this office — parking, transit, and nearby pharmacies are added as our data collection reaches each location.
Credentials and Medicare
| Licence | State | Specialty |
|---|---|---|
| 648.01 | RI | Mental Health Clinic/Center (Including… |
| 648.01 | RI | Substance Use Disorder Rehabilitation… |
This provider holds licence 648.01 issued in RI. A licence number in NPPES reflects what was filed at registration — it does not confirm the licence is still active today.
- Status
- Approved
- Provider type
- Part B Supplier - Clinic/group Practice
- PAC ID
- 0840620894
Enrolled in Medicare 2 times, across 1 state:
| State | Enrollment ID | Provider type |
|---|---|---|
| Rhode Island | O20200415002461 | Part B Supplier - Clinic/group Practice |
| Rhode Island | O20200520002570 | Part B Supplier - Opioid Treatment Program (otp) |
Medicare enrolment is recorded as approved under the provider type Part B Supplier - Clinic/group Practice. There are 2 separate enrolment records. Multiple enrolments usually mean the provider bills Medicare from more than one practice location, or has kept an earlier enrolment after moving. Each record carries its own enrolment ID, listed above. Being enrolled means the provider can bill Medicare; it does not tell you whether they are currently accepting new Medicare patients. Call the office to confirm.
What Addiction Medicine covers
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. NUCC Health Care Provider Taxonomy, code 207RA0401X
All registered taxonomy codes
This provider registers 14 taxonomy codes. The primary code is what appears on most claims; the others record additional recognised specialties.
| Code | Specialty | Licence | State | |
|---|---|---|---|---|
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician Addiction Medicine | — | — | primary |
| 101Y00000X | Counselor | — | — | |
| 163WA0400X | Addiction (Substance Use Disorder) Registered Nurse Addiction (Substance Use Disorder) | — | — | |
| 175T00000X | Peer Specialist | — | — | |
| 103TC1900X | Counseling Psychologist Counseling | — | — | |
| 163WP2201X | Ambulatory Care Registered Nurse Ambulatory Care | — | — | |
| 101YM0800X | Mental Health Counselor Mental Health | — | — | |
| 133NN1002X | Nutrition Education Nutritionist Nutrition, Education | — | — | |
| 103TA0400X | Addiction (Substance Use Disorder) Psychologist Addiction (Substance Use Disorder) | — | — | |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor Addiction (Substance Use Disorder) | — | — | |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) Mental Health (Including Community Mental Health Center) | 648.01 | RI | |
| 261QR0405X | Substance Use Disorder Rehabilitation Clinic/Center Rehabilitation, Substance Use Disorder | 648.01 | RI | |
| 106H00000X | Marriage & Family Therapist | — | — | |
| 207RI0200X | Infectious Disease Physician Infectious Disease | — | — |
The taxonomy records how the provider classifies their own practice. It does not confirm which conditions they currently treat, whether they are accepting new patients, or which insurance they take — call the office for that.
Full NPPES record
An NPI-2 identifies an organization — a clinic, hospital, group practice, laboratory, or supplier. Individual clinicians working there hold their own NPI-1 numbers separately, so a bill may reference both.
| NPI | 1104317007 valid check digit |
|---|---|
| Entity type | Organization (NPI-2) |
| Enumeration date | May 25, 2018 |
| Last updated | Mar 23, 2026 |
| Status | Active |
| Practice address |
110 ELMWOOD AVE # A Providence, RI 02907 (401) 868-0654 |
| Mailing address |
110 ELMWOOD AVE Providence, RI 02907 |
Number check
How the check works, step by step
Every NPI carries a Luhn check digit — the same scheme used on credit cards. CMS prefixes the number with 80840 before computing it, which marks it as a US health identifier.
| Digit | 8 | 0 | 8 | 4 | 0 | 1 | 1 | 0 | 4 | 3 | 1 | 7 | 0 | 0 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Doubled? | — | ×2 | — | ×2 | — | ×2 | — | ×2 | — | ×2 | — | ×2 | — | ×2 |
| Value | 8 | 0 | 8 | 8 | 0 | 2 | 1 | 0 | 4 | 6 | 1 | 5 | 0 | 0 |
Sum = 43 · next multiple of 10 = 50 · check digit = 7 · actual last digit = 7
A valid check digit only means the number is well-formed. It does not mean the provider is licensed, active, or in good standing — those are separate questions answered by the sections above.