NPIMap

Organization Active NPI

Impakt Medical, LLC

  • Durable Medical Equipment & Medical Supplies
  • Santa Cruz, CA
National Provider Identifier
1417429648
Registry record updated Dec 28, 2018
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
700 Frederick St Ste 301
Santa Cruz, CA 95062-2239
Phone
(831) 304-0700
Fax
(916) 436-9054
NPI assigned
Dec 28, 2018
Last updated
Dec 28, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2018

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

700 Frederick St Ste 301
Santa Cruz, CA 95062-2239

Mailing address

9722 Fair Oaks Blvd Ste B
Fair Oaks, CA 95628-7039
Phone (916) 844-7800

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190315000590 CA DME Supplier - Medical Supply Company 1759626476 Practice locations: Santa Cruz, CA

Other NPIs with the same Medicare PAC ID 4

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

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.

Locations

700 Frederick St
Ste 301
Santa Cruz, CA 95062
Phone (408) 423-9300

NPI Registry JSON

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

{
    "created_epoch": "1545955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545955200000",
    "number": "1417429648",
    "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": "916-844-7800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 FREDERICK ST STE 301",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950622239",
            "telephone_number": "831-304-0700",
            "fax_number": "916-436-9054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPAKT MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-28",
        "last_updated": "2018-12-28",
        "status": "A",
        "authorized_official_last_name": "MAJERNIK",
        "authorized_official_first_name": "BRYANT",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Cruz, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2018; 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.