Individual provider Active NPI

Joshua Imwalle, PA-C

  • Physician Assistant
  • Florence, SC
National Provider Identifier
1316668593
Registry record updated Sep 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
555 E Cheves St
Florence, SC 29506-2617
Phone
(843) 777-2106
NPI assigned
Sep 7, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

555 E Cheves St
Florence, SC 29506-2617

Mailing address

2619 Prelude Path
Dayton, OH 45449-3356
Phone (937) 361-8864

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, OH2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230210000102 SC Practitioner - Physician Assistant 4587036017 Reassigns benefits to 1 organization
I20230814000265 OH Practitioner - Physician Assistant 4587036017 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Premier Health Specialists IncGroup PAC ID 5597708594, 576 clinicians

Practice addresses (Care Compare)

450 N Hyatt St
Suite 304
Tipp City, OH 45371-1433
Phone (937) 832-4773

6611 Clyo Rd
Suite D
Centerville, OH 45459-2785
Phone (937) 277-8988

9000 N Main St
Englewood, OH 45415-1184

Merit-based Incentive Payment System (MIPS)

Final score
81.38 of 100Reported as group
Quality
66.25
Promoting interoperability
100
Improvement activities
40
Cost
71.69

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
4583SCMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Health Specialists Inc CurrentSince Jun 19, 2023 Accepting new patients
Premier Health Specialists Inc CurrentSince Jun 19, 2023 Accepting new patients
Premier Heart Associates, Inc Past Accepting new patients

Locations

6611 Clyo Rd
Ste F
Dayton, OH 45459
Phone (937) 208-5300

30 E Apple St
#6258
Dayton, OH 45409
Phone (937) 208-5300

9000 N Main St
Ste 233
Englewood, OH 45415
Phone (937) 832-3150

3170 Kettering Blvd
Bldg 2
Moraine, OH 45439

450 N Hyatt St
Ste 304
Tipp City, OH 45371
Phone (937) 832-4773

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1662508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662508800000",
    "number": "1316668593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2619 PRELUDE PATH",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454493356",
            "telephone_number": "937-361-8864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 E CHEVES ST",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295062617",
            "telephone_number": "843-777-2106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMWALLE",
        "first_name": "JOSHUA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-09-07",
        "last_updated": "2022-09-07",
        "certification_date": "2022-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Florence, SC

Sources for this page

Verify at the official NPI Registry.