Impact Sports & Spine LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

IMPACT SPORTS & SPINE LLC

Practice address

9420 Key West Ave Ste 325
Rockville, MD 20850-6529

Phone

(703) 789-3216

NPI assigned

Jun 4, 2024

Organization subpart

No

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

Authorized official

Name

David Itskevich, DONPI 1477896934

Title

Co-Founder/Physician

Phone

(301) 363-9693

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Joseph Auriemma, M.D.

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Rockville, MD
  • NPI 1467863662

  DC

  Medicare reassignment NPD
• David Itskevich, D.O.

  • Physical Medicine & Rehabilitation Physician
  • Rockville, MD
  • NPI 1477896934
  NPD Authorized official

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

{
    "created_epoch": "1717459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722556800000",
    "number": "1598506552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9420 KEY WEST AVE STE 325",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208506529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9420 KEY WEST AVE STE 325",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208506529",
            "telephone_number": "703-789-3216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT SPORTS & SPINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-04",
        "last_updated": "2024-08-02",
        "certification_date": "2024-08-02",
        "status": "A",
        "authorized_official_last_name": "ITSKEVICH",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CO-FOUNDER/PHYSICIAN",
        "authorized_official_telephone_number": "301-363-9693",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2081S0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Precious Ilori
• Stephen Ime Akra
• Sirisha Immaneni
• Mark Alan Immergut, MD
• John Imonikhe
• In-House Ophthalmology Inc
• Naeha Inapanuri
• Lindsay Ince, PT
• Lori B Indenbaum, PA-C
• Indigo Nursing Services LLC

• Physical Medicine & Rehabilitation Physician in Rockville, MD
• Providers in Rockville, MD by specialty
• Physical Medicine & Rehabilitation Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2024; 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.