Impact Physician Group, Wisconsin LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

IMPACT PHYSICIAN GROUP, WISCONSIN LLC

Practice address

3200 S 103Rd St
Milwaukee, WI 53227-4104

Phone

(469) 640-6500

NPI assigned

Sep 3, 2021

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

Paul Miller

Title

Ceo

Phone

(678) 967-5599

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Practitioners 13

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.

• Tesfaye Habtetsion Gebremedhin, M.D.

  • Internal Medicine Physician
  • Menomonee Falls, WI
  • NPI 1780927657
  Medicare reassignment Care Compare group NPD
• Krishna Chaitanya Kottapalli, MD

  • Internal Medicine Physician
  • Melrose Park, IL
  • NPI 1952678286

  WI

  Medicare reassignment Care Compare group NPD
• Melissa Arocho, APNP

  • Family Nurse Practitioner
  • Milwaukee, WI
  • NPI 1609641935
  Medicare reassignment NPD
• Wamiq Yahya Banday, MBBS, MD

  • Cardiovascular Disease Physician
  • Sheboygan, WI
  • NPI 1659520229

  Internal Medicine

  Medicare reassignment NPD
• Jessica Marie Denton, APNP

  • Family Nurse Practitioner
  • Wauwatosa, WI
  • NPI 1003599507
  Medicare reassignment NPD
• Mansoor Hussain Mirza, MD

  • Internal Medicine Physician
  • Sheboygan, WI
  • NPI 1508974502
  Medicare reassignment NPD
• Nicholas Christian Otten, MD

  • Hospitalist Physician
  • Burlington, WI
  • NPI 1013277714
  Medicare reassignment NPD
• Ashley Weiland

  • Family Nurse Practitioner
  • Mount Pleasant, WI
  • NPI 1841842697
  Medicare reassignment NPD
• Yasir Yafai, DO

  • Internal Medicine Physician
  • Milwaukee, WI
  • NPI 1205395381
  Medicare reassignment NPD
• Turgut Z Zia, MD

  • Internal Medicine Physician
  • Milwaukee, WI
  • NPI 1699783894
  Medicare reassignment NPD
• Kamran R Quraishi, M.D.

  • Internal Medicine Physician
  • Carmel, IN
  • NPI 1417175068

  WI

  Medicare reassignment NPD
• Joshua Raymond Babcock, PA-C

  • Physician Assistant
  • Mount Pleasant, WI
  • NPI 1093496192
  Medicare reassignment

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

{
    "created_epoch": "1630627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671408000000",
    "number": "1174291025",
    "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": "3200 S 103RD ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532274104",
            "telephone_number": "469-640-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT PHYSICIAN GROUP, WISCONSIN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-03",
        "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"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nasvin Imamudeen, MD
• Immaculate Transportation LLC
• Immaculate Transportation LLC
• Grace Rothstein Immel, PA-C
• Impact Alcohol & Other Drug Abuse Services, Inc.
• Impacthealth
• Impacthealth, LLC
• Gabriella Imrei, RPH
• In and Out Transportation LLC
• In Dreams Hands Supportive and Personal Care Services Inc.

• Internal Medicine Physician in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Internal Medicine Physician in Wisconsin

• 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.