Impact Prosthetic Solutions, LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

IMPACT PROSTHETIC SOLUTIONS, LLC

Doing business as

Impact Orthopedics
Impact Prosthetics & Orthotics

Practice address

3210 Prosperity Church Rd Ste 101
Charlotte, NC 28269-8194

Phone

(704) 510-2204

Fax

(704) 510-2218

NPI assigned

Feb 6, 2008

Organization subpart

No

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

Authorized official

Name

Rico Darryl Phronebarger

Title

Co-Owner/Manager

Phone

(704) 510-2204

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• Impact Orthopedics Doing business as
• Impact Prosthetics & Orthotics Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rondell L Richardson, CO, BOCP

  • Prosthetist
  • Charlotte, NC
  • NPI 1578763421
  NPD (past)

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

{
    "created_epoch": "1202256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1255519799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3210 PROSPERITY CHURCH RD STE 101",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282698194",
            "telephone_number": "704-510-2204",
            "fax_number": "704-510-2218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3210 PROSPERITY CHURCH RD STE 101",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282698194",
            "telephone_number": "704-510-2204",
            "fax_number": "704-510-2218"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2614 East 7th Street",
            "address_2": "Suite B",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282044375",
            "country_code": "US",
            "telephone_number": "704-510-2204",
            "fax_number": "704-510-2218",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "IMPACT PROSTHETIC SOLUTIONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-06",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "PHRONEBARGER",
        "authorized_official_first_name": "RICO",
        "authorized_official_middle_name": "DARRYL",
        "authorized_official_title_or_position": "CO-OWNER/MANAGER",
        "authorized_official_telephone_number": "704-510-2204"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7704797",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Impact Orthopedics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Impact Orthopedics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Impact Prosthetics & Orthotics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Impact Community Resources
• Impact Community Support Services, Inc.
• Impact Health Associates LLC
• Impact Healthcare Solutions LLC
• Impact Life Group Home LLC
• Alexandra Imperatore
• Leonila Importante, OTR/L
• Impressions Home Care LLC
• Hytham M Imseis, MD
• Roberto Antonio Yuson Imson, PT

• Prosthetic/Orthotic Supplier in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Prosthetic/Orthotic Supplier in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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.