IMPACT PHYSICIAN GROUP, WISCONSIN LLC
NPI 1174291025
Internal Medicine in Milwaukee, WI
About Impact Physician Group, Wisconsin Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
IMPACT PHYSICIAN GROUP, WISCONSIN LLC (NPI 1174291025) is a healthcare organization registered as an internal medicine in Milwaukee, Wisconsin and active in the NPI registry since September 2021. The organization lists Paul Miller, Ceo, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Impact Physician Group, Wisconsin Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by November 30, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
11Medicare enrollment records show 11 clinicians reassign Medicare billing to Impact Physician Group, Wisconsin LLC, which bills Medicare for the services they deliver. Of these, 4 practice within 10 miles. They are listed nearest first.
Clinicians by Medicare Specialty 5
Clinicians, nearest first (11)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Impact Physician Group, Wisconsin LLC's NPI number?
The NPI number for Impact Physician Group, Wisconsin LLC is 1174291025. It was assigned to this organization in the NPPES registry on September 3, 2021.
Where is Impact Physician Group, Wisconsin LLC located?
Impact Physician Group, Wisconsin LLC is located at 3200 S 103rd St, Milwaukee, WI 53227. The listed phone number is (469) 640-6500.
What is Impact Physician Group, Wisconsin LLC's specialty?
The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.
Is Impact Physician Group, Wisconsin LLC enrolled in Medicare?
Yes. Impact Physician Group, Wisconsin LLC is registered in the Medicare PECOS enrollment system.
When is Impact Physician Group, Wisconsin LLC's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Wisconsin, Clinic/Group Practice) is due for revalidation by November 30, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Impact Physician Group, Wisconsin LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 11 clinicians in 5 Medicare specialties reassign their Medicare billing to Impact Physician Group, Wisconsin LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Internal Medicine (5), Nurse Practitioner (3) and Cardiovascular Disease (Cardiology) (1). Of these, 4 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
What insurance does Impact Physician Group, Wisconsin LLC accept?
Health plans from Anthem Blue Cross and Blue Shield list Impact Physician Group, Wisconsin LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Impact Physician Group, Wisconsin LLC was last updated on December 19, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Impact Physician Group, Wisconsin Llc · NPI 1174291025
Internal Medicine organization in Milwaukee, Wisconsin. Organization record, active in the CMS NPPES registry since September 3, 2021.
## Identity
- **NPI:** 1174291025 (Entity type: Organization)
- **Enumerated:** September 3, 2021
- **Primary specialty:** Internal Medicine · taxonomy 207R00000X
- **Organization subpart:** No
- **Authorized official:** Paul Miller, CEO
## Practice location
- **Address:** 3200 S 103RD ST, Milwaukee, WI 53227-4104
- **Phone:** (469) 640-6500
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** November 30, 2026 (Non-DME Part B, Wisconsin, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 11 clinicians in 5 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Internal Medicine (5), Nurse Practitioner (3), Cardiovascular Disease (Cardiology) (1); 4 practice within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** December 19, 2022
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Source: [NPI Profile](https://npiprofile.com/npi/1174291025) · Data from the CMS NPPES public registry.