Impact Healthcare, PLLC
Organization Active NPI Addiction Medicine (Family Medicine) Physician · Jackson, TN
NPI 1487185153 · NPPES record last updated May 14, 2026
Key facts
- NPI
- 1487185153
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Addiction Medicine (Family Medicine) Physician 207QA0401X
- Legal business name
- IMPACT HEALTHCARE, PLLC
- Practice address
- 37 Sandstone Cir
Ste 92
Jackson, TN 38305-2089 - Phone
- (731) 445-4879
- NPI assigned
- Mar 24, 2017
- Organization subpart
- No
Authorized official
- Name
- Patrick Combs
- Title
- Ceo
- Phone
- (205) 208-9312
Other NPIs on the same Medicare enrollment 1
Practitioners 13
-
Logan Butler, PMHNP-BC
-
Ira Keith Ellis, MD
-
Billy Davis, DO
-
Stuart David Milan, PMHNP
-
Leslie Cole, M.D.
-
Tiffany Dupree, CRNP
-
Stephen Mark Taylor, M.D.
-
Kimberly Fowler, LCSW
-
Kevin Lucas Ledford, MS, NCC, LADAC II
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D2128897 | Boyett Healthcare of Tennessee | Certificate of waiver | Apr 9, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180201001424 | TN | Part B Supplier - Clinic/Group Practice | 5991065427 |
Receives reassigned benefits from 10 practitioners 1 other NPI on this enrollment Practice locations: Jackson, TN; Springfield, TN |
National Provider Directory
Locations
37 Sandstone Cir
Ste 92A
Jackson, TN 38305
Phone (731) 265-6025
104 Cude Ln
Ste 168
Madison, TN 37115
Phone (615) 868-9959
103 Cude Ln
Ste 168
Madison, TN 37115
1101 Fox Meadows Blvd
Ste 105
Sevierville, TN 37862
Phone (615) 382-3002
801 Hill St
#A
Springfield, TN 37172
801 Hill St
Ste 100
Springfield, TN 37172
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction Medicine (Family Medicine) Physician |
207QA0401X | Yes |
Addresses
Primary practice location
37 Sandstone Cir
Ste 92
Jackson, TN 38305-2089
Mailing address
48 Medical Park Dr E Ste 453
Birmingham, AL 35235-3472
Phone (205) 208-9312
Other practice location 1
801 Hill St Ste A
Springfield, TN 37172-2951
Phone (615) 382-3002
Other names
- Impact Healthcare LLC
- Boyett Healthcare of Tennessee
Other providers in Jackson, TN
- Esam Ibrahim
- Ih Physician Services PC
- Imind Geriatrics and Behavioral Health LLC
- Imind Mental Health and Wellness LLC
- Impact Behavioral Counseling LLC
- Independent Physical Therapy LLC
- Divya Lakshmi Indrakanti
- Infectious Disease Consultants of Jackson, PC
- Infinite Rehab and Wellness LLC
- Lakisha T Ingram
All providers in Jackson, TN · Addiction Medicine (Family Medicine) Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 14, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.