| Impact Physician Group, Ohio Llc | |
|
23333 Harvard Rd Beachwood OH 44122-6232 | |
| (216) 593-2200 | |
| Not Available |
| Full Name | Impact Physician Group, Ohio Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 23333 Harvard Rd, Beachwood, Ohio |
| Authorized Official Name and Position | Paul Miller (CEO) |
| Authorized Official Contact | 6789675599 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Impact Physician Group, Ohio Llc 21 Eastbrook Bnd Ste 218 Peachtree City GA 30269-1546 Ph: (678) 967-5599 | Impact Physician Group, Ohio Llc 23333 Harvard Rd Beachwood OH 44122-6232 Ph: (216) 593-2200 |
| NPI Number | 1063078749 |
|---|---|
| Provider Enumeration Date | 05/17/2019 |
| Last Update Date | 12/19/2022 |
| Medicare PECOS PAC ID | 6608288162 |
|---|---|
| Medicare Enrollment ID | O20201208000942 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063078749 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Alexandra M Koehn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861672339 PECOS PAC ID: 7012153059 Enrollment ID: I20130418000332 |
| Provider Name | Angela Mclearen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346690674 PECOS PAC ID: 8123313079 Enrollment ID: I20160817001189 |
| Provider Name | Jibran K Durrani |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750797262 PECOS PAC ID: 8527378850 Enrollment ID: I20201209001511 |
| Provider Name | Stephanie Paige Jones Friedstrom |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629654637 PECOS PAC ID: 0042628661 Enrollment ID: I20210421000262 |
| Provider Name | Megha Patel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972035574 PECOS PAC ID: 9830467026 Enrollment ID: I20240502002796 |
| Provider Name | Sheryar Sarwar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730426958 PECOS PAC ID: 0941500714 Enrollment ID: I20241216002474 |
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