NPIMap

Organization Active NPI

Impakt Medical, LLC

  • Durable Medical Equipment & Medical Supplies
  • Los Gatos, CA
National Provider Identifier
1376143479
Registry record updated Oct 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
IMPAKT MEDICAL, LLC
Practice address
14125 Capri Dr Ste 8
Los Gatos, CA 95032-1516
Phone
(408) 331-7773
Fax
(833) 227-8034
NPI assigned
Oct 28, 2020
Last updated
Oct 28, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2020

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

Authorized official

Name
Bryant P Majernik
Title
Vice President
Phone
(916) 844-7800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU Primary

Addresses

Primary practice location

14125 Capri Dr Ste 8
Los Gatos, CA 95032-1516

Mailing address

9722 Fair Oaks Blvd Ste B
Fair Oaks, CA 95628-7039
Phone (408) 480-5811

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201215001462 CA DME Supplier - Medical Supply CompanyDME Supplier - Oxygen & Equipment 1759626476 Practice locations: Los Gatos, CA

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

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

SupplierSuppliesMedicare assignment
Los Gatos14125 Capri Dr, Los Gatos, CA 95032-1516(408) 331-7773 Continuous Positive Airway Pressure (CPAP) Devices|Nebulizer Equipment and/or Supplies|Oxygen Equipment and/or Supplies|Respiratory Assist Devices Accepts assignmentParticipating since Oct 13, 2018

National Provider Directory

National Provider Directory
Tax ID family
Impakt Medical LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1603843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603843200000",
    "number": "1376143479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9722 FAIR OAKS BLVD STE B",
            "city": "FAIR OAKS",
            "state": "CA",
            "postal_code": "956287039",
            "telephone_number": "408-480-5811",
            "fax_number": "833-227-8034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14125 CAPRI DR STE 8",
            "city": "LOS GATOS",
            "state": "CA",
            "postal_code": "950321516",
            "telephone_number": "408-331-7773",
            "fax_number": "833-227-8034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPAKT MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-28",
        "last_updated": "2020-10-28",
        "certification_date": "2020-10-27",
        "status": "A",
        "authorized_official_last_name": "MAJERNIK",
        "authorized_official_first_name": "BRYANT",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "916-844-7800"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Gatos, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2020; 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.