NPIMap

Organization Active NPI

Impact Physician Group, Cardiology LLC

  • Cardiovascular Disease Physician
  • Elgin, SC
National Provider Identifier
1780274522
Registry record updated Dec 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
IMPACT PHYSICIAN GROUP, CARDIOLOGY LLC
Practice address
20 Pinnacle Pkwy
Elgin, SC 29045-8389
Phone
(803) 438-8890
NPI assigned
Jan 26, 2021
Last updated
Dec 19, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2022

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X Primary

Addresses

Primary practice location

20 Pinnacle Pkwy
Elgin, SC 29045-8389

Mailing address

21 Eastbrook BND Ste 218
Peachtree City, GA 30269-1546
Phone (678) 967-5599

Other practice location 1

1260 City Center Dr
Carmel, IN 46032-3810
Phone (463) 333-9110

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, SC, UT3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20210202000898 IN Part B Supplier - Clinic/Group Practice 5799199816 Receives reassigned benefits from 5 practitioners
Practice locations: Bloomington, IN; Mishawaka, IN; Lafayette, IN; Indianapolis, IN; Carmel, IN
O20210818002309 SC Part B Supplier - Clinic/Group Practice 5799199816 Receives reassigned benefits from 2 practitioners
Practice locations: Cayce, SC; Elgin, SC
O20240502003115 UT Part B Supplier - Clinic/Group Practice 5799199816 Receives reassigned benefits from 1 practitioner
Practice locations: Provo, UT; South Ogden, UT

National Provider Directory

National Provider Directory

Locations

3402 Anderson Healthcare Dr
#D
Edwardsville, IL 62025
Phone (618) 307-7900

306 W River Bend Ln
Sundance, UT 84604
Phone (801) 226-5838

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1611619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671408000000",
    "number": "1780274522",
    "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": "20 PINNACLE PKWY",
            "city": "ELGIN",
            "state": "SC",
            "postal_code": "290458389",
            "telephone_number": "803-438-8890"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1260 City Center Dr",
            "address_purpose": "LOCATION",
            "city": "Carmel",
            "state": "IN",
            "postal_code": "460323810",
            "country_code": "US",
            "telephone_number": "463-333-9110",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "IMPACT PHYSICIAN GROUP, CARDIOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-26",
        "last_updated": "2022-12-19",
        "certification_date": "2022-12-19",
        "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": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elgin, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2022; 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.