Impact Rehabilitation Center Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

PT26858 Issued in CA

Legal business name

IMPACT REHABILITATION CENTER INC

Practice address

255 N Tustin St
Orange, CA 92867-7772

Phone

(714) 288-9125

Fax

(714) 288-9129

NPI assigned

Jul 23, 2006

Reactivated

Aug 8, 2018

Last updated

Mar 30, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Willis Mark Sutcliff, MPT, ATCNPI 1073534905

Title

President

Phone

(714) 288-9125

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 4

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.

• Willis Mark Sutcliff, MPT, ATC

  • Physical Therapist
  • Orange, CA
  • NPI 1073534905
  Medicare reassignment Care Compare group NPD Authorized official
• Diana Finn Sutcliff, DPT

  • Physical Therapist
  • Orange, CA
  • NPI 1578587457
  Medicare reassignment Care Compare group NPD
• Joshua Drage Watson, PT, DPT

  • Physical Therapist
  • San Juan Capistrano, CA
  • NPI 1114557147
  Medicare reassignment NPD
• Jeremy Reed, PT

  • Physical Therapist
  • Orange, CA
  • NPI 1467942714
  NPD (past)

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

{
    "created_epoch": "1153612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585526400000",
    "number": "1801817739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5986",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928635986",
            "telephone_number": "714-288-9125",
            "fax_number": "714-288-9129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 N TUSTIN ST",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928677772",
            "telephone_number": "714-288-9125",
            "fax_number": "714-288-9129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT REHABILITATION CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-23",
        "last_updated": "2020-03-30",
        "certification_date": "2020-03-30",
        "deactivation_date": "2018-07-13",
        "reactivation_date": "2018-08-08",
        "status": "A",
        "authorized_official_last_name": "SUTCLIFF",
        "authorized_official_first_name": "WILLIS",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-288-9125",
        "authorized_official_credential": "MPT, ATC"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "PT26858",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GPT001400",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kyoungbin Im, M.D.
• David K Imagawa, MD
• Amir Imanzadeh, M.D.
• Graciela Lia Imbastari, MD
• Eric Masayoshi Imoto
• Impala Medical Group
• Impartial Behavioral Therapy
• Bismah Ayesha Imran
• Zsofia E Imre, PHD
• In Good Hands Ortho

• Specialist in Orange, CA
• Providers in Orange, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2020; 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.