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

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.

• 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": "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": "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"
        },
        {
            "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": "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"
        }
    ],
    "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.