NPIMap

Organization Active NPI

Impakt Medical, LLC

  • Oxygen Equipment & Supplies (DME)
  • Fair Oaks, CA
National Provider Identifier
1992299838
Registry record updated Jun 14, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X
License
99174 Issued in CA
Legal business name
IMPAKT MEDICAL, LLC
Practice address
9722 Fair Oaks Blvd Ste B
Fair Oaks, CA 95628-7039
Phone
(916) 844-7800
Fax
(833) 227-8034
NPI assigned
Jun 14, 2018
Last updated
Jun 14, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2018

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

Authorized official

Name
Bryant Majernik
Title
Owner / Vice President
Phone
(916) 844-7800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oxygen Equipment & Supplies (DME) 332BX2000X 99174 CA Primary

Addresses

Primary practice location

9722 Fair Oaks Blvd Ste B
Fair Oaks, CA 95628-7039

Mailing address

9722 Fair Oaks Blvd Ste B
Fair Oaks, CA 95628-7039
Phone (916) 844-7800

Other names 1

  • Impakt Medical, LLC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181227000065 CA DME Supplier - Medical Supply CompanyDME Supplier - Oxygen & Equipment 1759626476 Practice locations: Fair Oaks, CA

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Impakt Medical LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1528934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528934400000",
    "number": "1992299838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9722 FAIR OAKS BLVD STE B",
            "city": "FAIR OAKS",
            "state": "CA",
            "postal_code": "956287039",
            "telephone_number": "916-844-7800",
            "fax_number": "833-227-8034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9722 FAIR OAKS BLVD STE B",
            "city": "FAIR OAKS",
            "state": "CA",
            "postal_code": "956287039",
            "telephone_number": "916-844-7800",
            "fax_number": "833-227-8034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPAKT MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-14",
        "last_updated": "2018-06-14",
        "status": "A",
        "authorized_official_last_name": "MAJERNIK",
        "authorized_official_first_name": "BRYANT",
        "authorized_official_title_or_position": "OWNER / VICE PRESIDENT",
        "authorized_official_telephone_number": "916-844-7800"
    },
    "taxonomies": [
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "CA",
            "license": "99174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Impakt Medical, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Fair Oaks, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2018; 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.