Impact Orthopedics & Sports Medicine, LLC

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

Legal business name

IMPACT ORTHOPEDICS & SPORTS MEDICINE, LLC

Practice address

5200 W 94TH Ter Ste 113
Prairie Village, KS 66207-2522

Phone

(913) 906-8640

Fax

(913) 906-8682

NPI assigned

Apr 5, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Gabriel Azzam, MDNPI 1215258736

Title

Owner

Phone

(913) 906-8640

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in KS2 enrollments

Enrollment records 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Gabriel Azzam, M.D.

  • Orthopaedic Surgery Physician
  • Prairie Village, KS
  • NPI 1215258736
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1617580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640304000000",
    "number": "1023697406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 W 94TH TER STE 113",
            "city": "PRAIRIE VILLAGE",
            "state": "KS",
            "postal_code": "662072522",
            "telephone_number": "913-906-8640",
            "fax_number": "913-906-8682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5200 W 94TH TER STE 113",
            "city": "PRAIRIE VILLAGE",
            "state": "KS",
            "postal_code": "662072522",
            "telephone_number": "913-906-8640",
            "fax_number": "913-906-8682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT ORTHOPEDICS & SPORTS MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-05",
        "last_updated": "2021-12-24",
        "certification_date": "2021-12-24",
        "status": "A",
        "authorized_official_last_name": "AZZAM",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "GABRIEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "913-906-8640",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cody Hullman, PT
• Kimberly Hunt, DC
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• I Can Therapy LLC
• Samuel Aaron Ingram, PT
• Taylor Ivie-Mott
• Merri Patience Jacobs, COTA
• Jaime Duke LLC
• Brandon Allen James, DDS

• Orthopaedic Surgery Physician in Prairie Village, KS
• Providers in Prairie Village, KS by specialty
• Orthopaedic Surgery Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.