Impact Physician Group, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

IMPACT PHYSICIAN GROUP, LLC

Practice address

21 Eastbrook BND Ste 218
Peachtree City, GA 30269-1546

Phone

(678) 967-5599

NPI assigned

Feb 21, 2018

Last updated

Dec 19, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Paul Miller

Title

Ceo

Phone

(678) 967-5599

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in IN, FL, SC, CO, WA, MS, OR, UT, TN9 enrollments

Enrollment records 9

Locations

Practitioners 73

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Main Adawy

  • Family Nurse Practitioner
  • Arlington, TN
  • NPI 1063220036
  Medicare reassignment Care Compare group NPD
• Bryan R. Bartholomew, DO

  • Hospitalist Physician
  • Bountiful, UT
  • NPI 1407956121

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Anton Alexi Cabellon, D.O.

  • Nephrology Physician
  • Indianapolis, IN
  • NPI 1013006972
  Medicare reassignment Care Compare group NPD
• Johnny Nguon Cheng, D.O.

  • Hospitalist Physician
  • Denver, CO
  • NPI 1306107560

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Joshua Choate, APRN

  • Acute Care Nurse Practitioner
  • Germantown, TN
  • NPI 1023818127
  Medicare reassignment Care Compare group NPD
• Tia Helton, NP

  • Family Nurse Practitioner
  • Germantown, TN
  • NPI 1447062476
  Medicare reassignment Care Compare group NPD
• Fahad Jamil, M.D.

  • Hospitalist Physician
  • Bend, OR
  • NPI 1881075513

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Richard John, DO

  • Family Medicine Physician
  • Logan, UT
  • NPI 1649894692
  Medicare reassignment Care Compare group NPD
• Muhammad Farhan Khaliq, M.D.

  • Internal Medicine Physician
  • Clackamas, OR
  • NPI 1790168409
  Medicare reassignment Care Compare group NPD
• Steven Li

  • Internal Medicine Physician
  • Mullica Hill, NJ
  • NPI 1801411046

  CO

  Medicare reassignment Care Compare group NPD
• Harrison Charles Lowell, APRN-NP

  • Acute Care Nurse Practitioner
  • Centennial, CO
  • NPI 1568070571
  Medicare reassignment Care Compare group NPD
• Mohammed Mahmood, M.D.

  • Family Medicine Physician
  • Paducah, KY
  • NPI 1962815399

  TN

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1519171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671408000000",
    "number": "1114428612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 EASTBROOK BND STE 218",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302691546",
            "telephone_number": "678-967-5599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 EASTBROOK BND STE 218",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302691546",
            "telephone_number": "678-967-5599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT PHYSICIAN GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-21",
        "last_updated": "2022-12-19",
        "certification_date": "2022-12-19",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "678-967-5599",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Frazier Hurley
• Kristin Anne Hutchinson, PHARMD.
• Impact Physician Group Indiana Pulmonary Services LLC
• Impact Physician Group North Carolina LLC
• Impact Physician Group Virginia LLC
• In Charge Medical Professionals LLC
• Independent Physical Therapy of Ga, LLC
• Innovative Physical Therapy LLC
• Insight Assessment Solutions
• Integrated Care Resources of Georgia, LLC

• Internal Medicine Physician in Peachtree City, GA
• Providers in Peachtree City, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2022; 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.