Impact Physician Group, Texas LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

IMPACT PHYSICIAN GROUP, TEXAS LLC

Practice address

302 Gobblers Knob Rd
Lufkin, TX 75904-5419

Phone

(936) 632-2295

NPI assigned

May 20, 2020

Organization subpart

No

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

Authorized official

Name

Paul Miller

Title

Ceo

Phone

(678) 967-5599

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 8

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

• Rose Gaelle Moale, FNP

  • Family Nurse Practitioner
  • Midland, TX
  • NPI 1417544347
  Medicare reassignment Care Compare group NPD
• Zubair Khan, M.D

  • Internal Medicine Physician
  • Indianapolis, IN
  • NPI 1134416019

  TX

  Medicare reassignment Care Compare group NPD
• Abdul Moiz, MD

  • Nephrology Physician
  • Indianapolis, IN
  • NPI 1760672760

  Internal Medicine, TX

  Medicare reassignment Care Compare group NPD
• Akta Rajani, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Plano, TX
  • NPI 1003264334
  Medicare reassignment NPD
• Sajita Shiwakoti

  • Nurse Practitioner
  • Carrollton, TX
  • NPI 1922782200
  Medicare reassignment NPD
• Ashishkumar Kanu Patel, M.D.

  • Neonatal-Perinatal Medicine Physician
  • Phoenix, AZ
  • NPI 1689811176

  TX

  Medicare reassignment NPD
• Haris Adnan Siraj, MD

  • Internal Medicine Physician
  • Indianapolis, IN
  • NPI 1982045902

  TX

  Medicare reassignment NPD
• Sheryar Sarwar, MD

  • Family Medicine Physician
  • Kokomo, IN
  • NPI 1730426958
  NPD (past)

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

{
    "created_epoch": "1589932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694736000000",
    "number": "1740803113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 EASTBROOK BND STE 218",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302691546",
            "telephone_number": "678-967-5599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 GOBBLERS KNOB RD",
            "city": "LUFKIN",
            "state": "TX",
            "postal_code": "759045419",
            "telephone_number": "936-632-2295"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3300 Farm to Market 1788",
            "address_purpose": "LOCATION",
            "city": "Midland",
            "state": "TX",
            "postal_code": "79706",
            "country_code": "US",
            "telephone_number": "432-561-5915",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1023 N Belt Line Rd",
            "address_purpose": "LOCATION",
            "city": "Mesquite",
            "state": "TX",
            "postal_code": "751491788",
            "country_code": "US",
            "telephone_number": "972-216-2400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4302 Princeton St",
            "address_purpose": "LOCATION",
            "city": "Lubbock",
            "state": "TX",
            "postal_code": "794151304",
            "country_code": "US",
            "telephone_number": "806-749-2222",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8903 Floyd Curl Dr",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782403482",
            "country_code": "US",
            "telephone_number": "469-640-6500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "906 James St",
            "address_purpose": "LOCATION",
            "city": "Weslaco",
            "state": "TX",
            "postal_code": "785969840",
            "country_code": "US",
            "telephone_number": "956-969-2222",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "615 Clinic Dr",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "TX",
            "postal_code": "756055172",
            "country_code": "US",
            "telephone_number": "903-212-3105",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "425 E Alton Gloor Blvd",
            "address_purpose": "LOCATION",
            "city": "Brownsville",
            "state": "TX",
            "postal_code": "785263361",
            "country_code": "US",
            "telephone_number": "956-554-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "IMPACT PHYSICIAN GROUP, TEXAS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-20",
        "last_updated": "2023-09-15",
        "certification_date": "2023-09-14",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "678-967-5599"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patrick Imonitie Igharosa, MD
• Christopher Max Iguess, FNP
• IHS Acquisition No 139 Inc
• IHS Aquisition No 139 Inc
• Impact Physician Group, Psychiatry LLC
• In & Out Clinic PA
• Charlotte Ann Ingle, M.A.
• Shaleta Ingram, CNP
• Kyle Leann Inman, RN
• Innovative Homes of Deep East Texas, Inc.

• Internal Medicine Physician in Lufkin, TX
• Providers in Lufkin, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2023; 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.