Impact Physician Group, Missouri, Llc - Medicare Primary Care in Bridgeton, MO

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Impact Physician Group, Missouri, Llc is a medicare enrolled primary clinic (Internal Medicine) in Bridgeton, Missouri. The current practice location for Impact Physician Group, Missouri, Llc is 12380 De Paul Dr, Bridgeton, Missouri. For appointments, you can reach them via phone at (314) 447-9700. The mailing address for Impact Physician Group, Missouri, Llc is 21 Eastbrook Bnd Ste 218, Peachtree City, Georgia and phone number is (678) 967-5599.

Impact Physician Group, Missouri, Llc is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its NPI number is 1962971531. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (314) 447-9700.

Contact Information

Impact Physician Group, Missouri, Llc
12380 De Paul Dr
Bridgeton
MO 63044-2511
(314) 447-9700
Not Available

Map and Direction


Primary Care Clinic Profile

Full NameImpact Physician Group, Missouri, Llc
SpecialityInternal Medicine
Location12380 De Paul Dr, Bridgeton, Missouri
Authorized Official Name and PositionPaul Miller (CEO)
Authorized Official Contact6789675599
Accepts Medicare InsuranceYes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Impact Physician Group, Missouri, Llc
21 Eastbrook Bnd Ste 218
Peachtree City
GA 30269-1546

Ph: (678) 967-5599		Impact Physician Group, Missouri, Llc
12380 De Paul Dr
Bridgeton
MO 63044-2511

Ph: (314) 447-9700

NPI Details:

NPI Number1962971531
Provider Enumeration Date11/13/2018
Last Update Date12/19/2022

Medicare PECOS Information:

Medicare PECOS PAC ID4082958574
Medicare Enrollment IDO20181211001514

Medical Identifiers

Medical identifiers for Impact Physician Group, Missouri, Llc such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1962971531NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
207R00000XInternal Medicine (* (Not Available))Primary
207RE0101XInternal Medicine - Endocrinology, Diabetes & Metabolism (* (Not Available))Secondary
207RG0100XInternal Medicine - Gastroenterology (* (Not Available))Secondary
207RP1001XInternal Medicine - Pulmonary Disease (* (Not Available))Secondary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Impact Physician Group, Missouri, Llc acts as a billing entity for following providers:
Provider NameRadhika Jaladi
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1376516302
PECOS PAC ID: 8729031521
Enrollment ID: I20050422000086
Provider NameBrenda S Gottuso
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1902846694
PECOS PAC ID: 2163445958
Enrollment ID: I20060106000722
Provider NameUmesh I Gandhi
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1205056660
PECOS PAC ID: 8527111384
Enrollment ID: I20090929000366
Provider NameIlir Polovina
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1952540999
PECOS PAC ID: 5991820102
Enrollment ID: I20100910001149
Provider NameSumera Yaqub
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1356653463
PECOS PAC ID: 8022327378
Enrollment ID: I20151027002580
Provider NameCarl K Callahan
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1750755849
PECOS PAC ID: 9830490788
Enrollment ID: I20151217001519
Provider NameKathleen A Konys
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1073056578
PECOS PAC ID: 8022392562
Enrollment ID: I20170316001520
Provider NameArfaa Hardi Ali
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1295146421
PECOS PAC ID: 6406158864
Enrollment ID: I20170623000488
Provider NameRenu Teckchandani
Provider TypePractitioner - Hospitalist
Provider IdentifiersNPI Number: 1831477421
PECOS PAC ID: 6608092119
Enrollment ID: I20170724001413
Provider NameBeth Ann Dalrymple-woods
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1194950816
PECOS PAC ID: 6204102171
Enrollment ID: I20171019002976
Provider NameMark Knotts
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1750809224
PECOS PAC ID: 0446516298
Enrollment ID: I20171109003525
Provider NameSamera Majeed
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1578959193
PECOS PAC ID: 8820376270
Enrollment ID: I20180801000725
Provider NameJunaid Munshi
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1629411129
PECOS PAC ID: 1254657216
Enrollment ID: I20180815002576
Provider NameAlice Q Torregosa
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1134635022
PECOS PAC ID: 6204188055
Enrollment ID: I20181006000246
Provider NameKamran Hussaini
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1215347125
PECOS PAC ID: 5597067918
Enrollment ID: I20181010003643
Provider NameJoshua Njenga
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1871023002
PECOS PAC ID: 8729330931
Enrollment ID: I20181016001373
Provider NameHelen Smith
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1982184966
PECOS PAC ID: 1850644253
Enrollment ID: I20181101001971
Provider NameLucija Sadl
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1912413584
PECOS PAC ID: 7315282480
Enrollment ID: I20181218000861
Provider NameLubasi Akombelwa
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1811489479
PECOS PAC ID: 5193060135
Enrollment ID: I20181220000841
Provider NameMuhammad R Dalal
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1598179517
PECOS PAC ID: 6608179155
Enrollment ID: I20190110001004
Provider NameKahee Mohammed
Provider TypePractitioner - Hospitalist
Provider IdentifiersNPI Number: 1215382189
PECOS PAC ID: 9234427386
Enrollment ID: I20190823003536
Provider NameGladys Waturi Gitau
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1841855335
PECOS PAC ID: 8527397256
Enrollment ID: I20190905002911
Provider NameZubair Khan
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1134416019
PECOS PAC ID: 0840410403
Enrollment ID: I20191112002586
Provider NameCatherine N Kagotho
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1740714724
PECOS PAC ID: 7618300377
Enrollment ID: I20191210003497
Provider NameSai Prashanth Babu Palepu
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1558673152
PECOS PAC ID: 3072757616
Enrollment ID: I20191212000345
Provider NameMary Cecelia Randell
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1760020234
PECOS PAC ID: 3476987181
Enrollment ID: I20200103002015
Provider NameRavinderpal Nandra
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1639358427
PECOS PAC ID: 7911052162
Enrollment ID: I20201023002099
Provider NameCecilia Yvonne Ravas
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1043728264
PECOS PAC ID: 5890106108
Enrollment ID: I20201117002677

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Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.