IMPACT PHYSICIAN GROUP, MISSOURI, LLC (NPI# 1962971531) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962971531 |
| Entity Type | Organization |
| Organization Name | IMPACT PHYSICIAN GROUP, MISSOURI, LLC |
| Practice Address |
12380 Depaul Dr Bridgeton MO 63044-2727 |
| Mailing Address |
21 Eastbrook Bnd Ste 218 Peachtree City GA 30269-1546 |
| Practice Telephone | 6789675599 |
| Mailing Telephone | 6789675599 |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2018-11-13 |
| Authorized Official Name | MR. PAUL MILLER (CEO) |
| Authorized Official Telephone | 6786994977 |
| Is Organization Subpart | Y |
| Parent Organization Name | IMPACT PHYSICIAN GROUP, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RE0101X |
Internal Medicine Specialization: Endocrinology, Diabetes & Metabolism |
Allopathic & Osteopathic Physicians | ||
| N | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
Allopathic & Osteopathic Physicians | ||
| N | 207RP1001X |
Internal Medicine Specialization: Pulmonary Disease |
Allopathic & Osteopathic Physicians | ||
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| Street Address |
12380 DEPAUL DR |
| City | BRIDGETON |
| State | MO |
| Zip Code | 63044-2727 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548696727 | Hannah Mcglynn | Physical Therapist | 12380 Depaul Dr, Bridgeton, MO 63044 | 2013-09-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073150017 | Zoe Marie Wadsworth | Nurse Practitioner | 12255 Depaul Dr Suite 300, Bridgeton, MO 63044 | 2019-12-10 |
| 1609412451 | Beyond Better, Best Home Health Care Services, Limited Liability Corpo | In Home Supportive Care | 3430 Mckelvey Road Ste B, Bridgeton, MO 63044 | 2019-11-26 |
| 1275189078 | Delicate Angels Home Health LLC | Home Health | 11726 St. Charles Rock Road Suite G, Bridgeton, MO 63044 | 2019-08-16 |
| 1588210082 | Nicholas Huber | Physical Therapist | 12349 Depaul Dr., Ste. 110, Bridgeton, MO 63044 | 2019-08-12 |
| 1124688858 | Michelle Bassett | Registered Nurse | 11520 St. Charles Rock Rd., Suite 106, Bridgeton, MO 63044 | 2019-06-14 |
| 1336703883 | Elena A Barrow | Nurse Practitioner | 12255 Depaul Dr, Suite 260, Bridgeton, MO 63044 | 2019-04-30 |
| 1487123105 | Laura N Steiner | Registered Nurse | Gateway Pediatrics, Ltd, 12255 Depaul Drive, Suite 460 North Medical Building, Bridgeton, MO 63044 | 2018-11-26 |
| 1205310950 | Danielle Mathis | Nurse Practitioner | 3440 Depaul Lane Suite 201, Bridgeton, MO 63044 | 2018-09-19 |
| 1588163570 | Thoughts Out Loud Counseling, LLC | Social Worker | 11520 St. Charles Rock Road Suite 101, Bridgeton, MO 63044 | 2018-02-06 |
| 1912411430 | Breanna Victoria Hayes | Counselor | 3165 Mckevley Road, Suite 200, Bridgeton, MO 63044 | 2017-11-20 |
| Find all providers in zip 63044 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174903256 | Christopher Struby | Internal Medicine | 201 Laurel Heights Dr # 201, Bridgeton, NJ 08302 | 2015-06-04 |
| 1548359607 | Stephen Hoey | Internal Medicine | 61 Casarow Dr, Bridgeton, NJ 08302-2244 | 2006-10-12 |
| 1730273772 | Ekram L Hanna | Internal Medicine | 201 Laurel Heights Drive, Bridgeton, NJ 08302-3635 | 2006-10-03 |
| 1376647644 | Bruce Jay Berwald | Internal Medicine | 3478 Bridgeland Dr, Bridgeton, MO 63044-2619 | 2006-09-08 |
| 1346350196 | Mohammad Amin Zaman | Internal Medicine | 11520 Saint Charles Rock Rd Ste 106, Bridgeton, MO 63044 | 2006-08-30 |
| 1497761589 | Ilyas Ahmed | Internal Medicine | 217 Laurel Heights Drive, Bridgeton, NJ 08302-3635 | 2006-07-31 |
| 1801826565 | Internal Medicine Associates, Pa | Internal Medicine | 201 Laurel Heights Dr, Bridgeton, NJ 08302-3635 | 2006-07-05 |
| 1598738262 | Steven W Baak | Internal Medicine | 3440 De Paul Ln, Suite 113, Bridgeton, MO 63044-3545 | 2006-02-10 |
| 1255930814 | Reddy Md LLC | Internal Medicine | 3394 Mckelvey Rd Ste 115, Bridgeton, MO 63044-2531 | 2020-10-23 |
| 1275012452 | Hospitalist Medicine Physicians of Missouri - Bridgeton, Inc. | Internal Medicine | 12303 De Paul Dr, Bridgeton, MO 63044-2512 | 2018-08-09 |
| Find all providers in BRIDGETON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.