Impact

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

Legal business name

IMPACT

Practice address

1260 Morena Blvd Ste 100
San Diego, CA 92110-3850

Phone

(619) 232-4357

NPI assigned

May 8, 2020

Last updated

Oct 14, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Tessa Sanchez

Title

Lead HR Specialist -Onboarding

Phone

(619) 275-0822

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• Community Research Foundation Other name

Electronic endpoints 1

Locations

Interoperability endpoints

• Direct secure messaging: cagcolicol@comresearch.org

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Safyyah Deseree Davis, LPN

  • Licensed Vocational Nurse
  • San Diego, CA
  • NPI 1477175602
  NPD
• Colin Cadman

  • Mental Health Counselor
  • San Diego, CA
  • NPI 1205132289
  NPD (past)
• Ashley Hanson

  • Mental Health Counselor
  • San Diego, CA
  • NPI 1417364860
  NPD (past)

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

{
    "created_epoch": "1588896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634169600000",
    "number": "1477175883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1260 MORENA BLVD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921103889",
            "telephone_number": "619-232-4357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1260 MORENA BLVD STE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921103850",
            "telephone_number": "619-232-4357"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2865 Logan Ave",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921132411",
            "country_code": "US",
            "telephone_number": "619-232-4357",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "IMPACT",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-08",
        "last_updated": "2021-10-14",
        "certification_date": "2021-10-14",
        "status": "A",
        "authorized_official_last_name": "SANCHEZ",
        "authorized_official_first_name": "TESSA",
        "authorized_official_title_or_position": "LEAD HR SPECIALIST -ONBOARDING",
        "authorized_official_telephone_number": "619-275-0822",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA BOARD OF VOCATIONAL NURSING AND PSYCHIATRIC TECHNICIANS",
            "identifier": "719792",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE PRACTICAL NURSE",
            "identifier": "201902804LPN",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE VOCATIONAL NURSE",
            "identifier": "VN719792",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "CAgcolicol@comresearch.org",
            "affiliation": "N",
            "endpointDescription": "Human Resources",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1260 Morena Blvd Ste 100",
            "city": "San Diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "921103850",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Community Research Foundation",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Community Research Foundation",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jessica Carrie Imhoff
• Shelby Nicole Imhoff
• Gregory Phillip Imler, M.D.
• Katherine Laura Immerman, M.D.
• Kayla Imms
• Impact Dance and Physical Therapy PC
• Impact Medical Associates California
• Impedimed Inc
• Chloe Christin Impellizeri
• Shannon Imper, LMFT

• Licensed Practical Nurse in San Diego, CA
• Providers in San Diego, CA by specialty
• Licensed Practical Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2021; 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.