Impact 13 Medical, PLLC

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

Legal business name

IMPACT 13 MEDICAL, PLLC

Practice address

10752 Deerwood Park Blvd
South Waterview II Suite 100
Jacksonville, FL 32256

Phone

(904) 755-1017

Fax

(646) 774-0386

NPI assigned

Nov 13, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Wil E Germain, MD

Title

Owner

Phone

(516) 412-1608

Specialties & licenses 5

Addresses

Locations

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

{
    "created_epoch": "1573603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576627200000",
    "number": "1548805617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10752 DEERWOOD PARK BLVD",
            "address_2": "SOUTH WATERVIEW II SUITE 100",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322568666",
            "telephone_number": "904-755-1017",
            "fax_number": "646-774-0386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10752 DEERWOOD PARK BLVD",
            "address_2": "SOUTH WATERVIEW II SUITE 100",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32256",
            "telephone_number": "904-755-1017",
            "fax_number": "646-774-0386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT 13 MEDICAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-13",
        "last_updated": "2019-12-18",
        "certification_date": "2019-12-18",
        "status": "A",
        "authorized_official_last_name": "GERMAIN",
        "authorized_official_first_name": "WIL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "516-412-1608",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Talat Imam, MD
• Erica Imaoka, DNP
• David Mathew Imbt, M.D.
• Mary Imhansiemhonehi
• Immediate Medical Care Corp
• Impact for Life Developmental Care LLC
• Impact Home Care Services LLC
• Imperial Medical Equipment LLC
• Imray & Gesek DMD PA
• In Good Company Homemaker & Companion Services LLC

• Neurology Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Neurology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2019; 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.