John P Impastato, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110004196 Issued in VA

Practice address

325 Charles H Dimmock Pkwy Ste 100
Colonial Heights, VA 23834-2986

Phone

(804) 526-5888

Fax

(804) 526-5401

NPI assigned

Jul 8, 2005

Last updated

Jul 24, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1120780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595548800000",
    "number": "1053319590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 CHARLES H DIMMOCK PKWY STE 100",
            "city": "COLONIAL HEIGHTS",
            "state": "VA",
            "postal_code": "238342986",
            "telephone_number": "804-526-5888",
            "fax_number": "804-526-5401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 CHARLES H DIMMOCK PKWY STE 100",
            "city": "COLONIAL HEIGHTS",
            "state": "VA",
            "postal_code": "238342986",
            "telephone_number": "804-526-5888",
            "fax_number": "804-526-5401"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13048 Rivers Bend Rd",
            "address_purpose": "LOCATION",
            "city": "Chester",
            "state": "VA",
            "postal_code": "238362564",
            "country_code": "US",
            "telephone_number": "804-526-5888",
            "fax_number": "804-526-5401",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "131 Jennick Dr",
            "address_purpose": "LOCATION",
            "city": "Colonial Heights",
            "state": "VA",
            "postal_code": "238344905",
            "country_code": "US",
            "telephone_number": "804-526-5888",
            "fax_number": "804-526-5401",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IMPASTATO",
        "first_name": "JOHN",
        "middle_name": "P",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-08",
        "last_updated": "2020-07-24",
        "certification_date": "2020-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C06773",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "1746",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110004196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1053319590",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Colonial Heights, VA
• Providers in Colonial Heights, VA by specialty
• Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.