Impact Care Access Network Inc

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

G69428 Issued in CA

Legal business name

IMPACT CARE ACCESS NETWORK INC

Practice address

9390 Hesperia Rd
Suite # 7
Hesperia, CA 92345-3602

Phone

(760) 998-2125

Fax

(760) 948-0723

NPI assigned

Jan 5, 2016

Last updated

Jan 5, 2016By 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

Dr. Philip Dimitrios Kouros, M.D.NPI 1972608677

Title

Medical Doctor

Phone

(760) 948-4219

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 5

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.

• Philip Dimitrios Kouros, M.D.

  • Family Medicine Physician
  • Los Angeles, CA
  • NPI 1972608677
  Medicare reassignment Authorized official
• Lisa L. Banks, D.P.M.

  • Podiatrist
  • Bakersfield, CA
  • NPI 1992945885
  Medicare reassignment
• Emanuel Jean-Pierre, PA-C

  • Physician Assistant
  • Fontana, CA
  • NPI 1649306457
  Medicare reassignment
• Lansdale John Peters, P.A-C

  • Medical Physician Assistant
  • Corona, CA
  • NPI 1902097926
  Medicare reassignment
• Nathan Williams

  • Adult Medicine Physician
  • Thermal, CA
  • NPI 1548345473
  Medicare reassignment

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

{
    "created_epoch": "1451952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451952000000",
    "number": "1861858904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9390 HESPERIA RD",
            "address_2": "SUITE # 7",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "923453602",
            "telephone_number": "760-998-2125",
            "fax_number": "760-948-0723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9390 HESPERIA RD",
            "address_2": "SUITE # 7",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "923453602",
            "telephone_number": "760-998-2125",
            "fax_number": "760-948-0723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT CARE ACCESS NETWORK INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-05",
        "last_updated": "2016-01-05",
        "status": "A",
        "authorized_official_last_name": "KOUROS",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "DIMITRIOS",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "760-948-4219",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "G69428",
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "CA",
            "license": "G69428",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Herleena Hunt
• Diane Huynh, PHARMD
• Ly Huynh, PHARMD
• Hyeyun Lee D.D.S., Inc.
• Impact Care Access Network II
• Giovanni Ingolia, CHW
• Inland Psychiatric Medical Group, Inc.
• Franklin Bradford Inouye, O..D.
• Feliciano Joseph Inzunza, PPS, ASC
• Paul J Iorio, ACSW

• Primary Care Clinic/Center in Hesperia, CA
• Providers in Hesperia, CA by specialty
• Primary Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2016; 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.