Impact Medical Group LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

IMPACT MEDICAL GROUP LLC

Practice address

2014 Ashley Oaks Cir
Wesley Chapel, FL 33544-6400

Phone

(813) 953-1002

NPI assigned

Mar 6, 2019

Last updated

Feb 28, 2022By 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

Melissa N Botbyl

Title

Administrator

Phone

(727) 272-4919

Specialties & licenses 3

Addresses

Locations

Practitioners 1

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.

• Stefanie Lorraine Wilde, D.C.

  • Chiropractor
  • Ocala, FL
  • NPI 1619906294
  NPD (past)

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

{
    "created_epoch": "1551830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646006400000",
    "number": "1992263164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7982",
            "city": "SEMINOLE",
            "state": "FL",
            "postal_code": "337757982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2014 ASHLEY OAKS CIR",
            "city": "WESLEY CHAPEL",
            "state": "FL",
            "postal_code": "335446400",
            "telephone_number": "813-953-1002"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2701 Park Dr Ste 2",
            "address_purpose": "LOCATION",
            "city": "Clearwater",
            "state": "FL",
            "postal_code": "337631021",
            "country_code": "US",
            "telephone_number": "813-953-1002",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "427 S Parsons Ave Ste 110",
            "address_purpose": "LOCATION",
            "city": "Brandon",
            "state": "FL",
            "postal_code": "335115252",
            "country_code": "US",
            "telephone_number": "813-536-0373",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6449 38th Ave N Ste E4",
            "address_purpose": "LOCATION",
            "city": "St Petersburg",
            "state": "FL",
            "postal_code": "337101654",
            "country_code": "US",
            "telephone_number": "813-953-1002",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6719 Gall Blvd Ste 202",
            "address_purpose": "LOCATION",
            "city": "Zephyrhills",
            "state": "FL",
            "postal_code": "335422569",
            "country_code": "US",
            "telephone_number": "352-648-9349",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9015 Town Center Pkwy Unit 112",
            "address_purpose": "LOCATION",
            "city": "Lakewood Ranch",
            "state": "FL",
            "postal_code": "342025012",
            "country_code": "US",
            "telephone_number": "941-222-1157",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11373 SW 211th St Ste 19",
            "address_purpose": "LOCATION",
            "city": "Miami",
            "state": "FL",
            "postal_code": "331892247",
            "country_code": "US",
            "telephone_number": "305-748-6020",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7360 SW 24th St Ste 16",
            "address_purpose": "LOCATION",
            "city": "Miami",
            "state": "FL",
            "postal_code": "331551482",
            "country_code": "US",
            "telephone_number": "786-933-7030",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "260 Crystal Grove Blvd",
            "address_purpose": "LOCATION",
            "city": "Lutz",
            "state": "FL",
            "postal_code": "335486460",
            "country_code": "US",
            "telephone_number": "727-849-1309",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "139 S Pebble Beach Blvd",
            "address_purpose": "LOCATION",
            "city": "Sun City Center",
            "state": "FL",
            "postal_code": "335735799",
            "country_code": "US",
            "telephone_number": "813-938-5195",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "IMPACT MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-06",
        "last_updated": "2022-02-28",
        "certification_date": "2022-02-28",
        "status": "A",
        "authorized_official_last_name": "BOTBYL",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "727-272-4919"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Wesley Chapel, FL
• Providers in Wesley Chapel, FL by specialty
• Chiropractor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.