Impact Healthcare, P.a.
Organization Active NPI Family Medicine Physician · Louisburg, NC
NPI 1124537246 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1124537246
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 2013-01723 (NC)
- Legal business name
- IMPACT HEALTHCARE, P.A.
- Practice address
- 315 Franklin PLZ
Louisburg, NC 27549-2765 - Phone
- (919) 496-4976
- NPI assigned
- Sep 20, 2017
- Organization subpart
- No
Authorized official
- Name
- Ms. Heather Johnson Montgomery, F-N.P
- Title
- Authorized Official
- Phone
- (919) 690-8588
Practitioners 16
-
Dana Pernell Browning, FNP-C
-
Kelly Meagan Brewer Coker, DNP, FNP-BC
-
Kristie Pernell Gitto, FNP-C
-
Kennedy U. Onori, PHD., FNP-BC
-
Loretta Mae Pearce, FNP-C
-
Kirsten Leigh Stephenson, FNP-BC
-
Sandra G Wilusz, FNP-BC
-
Latisha Darsha Patterson, PA-C
-
Kristen L White, PA-C
-
Demaura H Russell, M.D.
-
Jennifer Lynn Francis, PA-C
-
Joanne D Liles, NP
-
Mary Jo Oneal, FNP
-
Barbara Lori Pohlman, MD, MPH
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D2136745 | Impact Healthcare, PA | Provider-performed microscopy | Sep 13, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20171127002943 | NC | Part B Supplier - Clinic/Group Practice | 3476810532 |
Receives reassigned benefits from 13 practitioners Practice locations: Cedar Point, NC; Louisburg, NC |
National Provider Directory
Locations
1057D Cedar Point Blvd
Cedar Point, NC 28584
Phone (252) 764-2121
1057 Cedar Point Blvd
#D
Cedar Point, NC 28584
Phone (252) 764-2121
315 S Bickett Blvd
Louisburg, NC 27549
Phone (919) 496-4976
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 2013-01723 | NC | Yes |
Addresses
Primary practice location
315 Franklin PLZ
Louisburg, NC 27549-2765
Mailing address
315 Franklin PLZ
Louisburg, NC 27549-2765
Phone (919) 496-4976
Other names
- Impact Primary and Urgent Care
Other providers in Louisburg, NC
- Horizon Home Respiratory and
- Lauren Elizabeth Horner
- Howard G Yee, DMD PA
- Michelle Callahan Hughes
- Lauretta Ihenatu
- Joelle Jacobs
- James G. Hardy DDS
- Larita T Jenkins
- Rebecca Ann Jester
- Quenetta Michelle Johnson
All providers in Louisburg, NC · Family Medicine Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.