Icarus Medical, LLC.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

ICARUS MEDICAL, LLC.

Practice address

609 E Market St Ste 114
Charlottesville, VA 22902-5305

Phone

(434) 242-0258

Fax

(434) 270-7278

NPI assigned

May 18, 2020

Organization subpart

No

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

Authorized official

Name

Mr. David T Johnson

Title

Ceo

Phone

(434) 242-0258

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1589760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714521600000",
    "number": "1205459864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "609 E MARKET ST STE 114",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229025305",
            "telephone_number": "888-492-1101",
            "fax_number": "434-270-7278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 E MARKET ST STE 114",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229025305",
            "telephone_number": "434-242-0258",
            "fax_number": "434-270-7278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICARUS MEDICAL, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-18",
        "last_updated": "2024-05-01",
        "certification_date": "2024-05-01",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "434-242-0258",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Alexis Iaccarino, MD
• Carlos R Ibanez, DDS
• Christine Ibilibor, M.D., M.SC.
• Ahmed Ibrahim Elsayed Ibrahim
• Michael E Ibrahim, MD PHD
• Christina M Ide, PA
• William W Ide, MD
• Julia C. Iezzoni
• Lisa Igbani, MD
• Anthony Joseph Ignozzi, MD

• Durable Medical Equipment & Medical Supplies in Charlottesville, VA
• Providers in Charlottesville, VA by specialty
• Durable Medical Equipment & Medical Supplies in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.