NPIMap

Organization Active NPI

Iredell Physician Network LLC

Doing business as Iredell Endocrinology

  • Endocrinology, Diabetes & Metabolism Physician
  • Mooresville, NC
National Provider Identifier
1003081175
Registry record updated May 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
9400602 Issued in NC
Legal business name
IREDELL PHYSICIAN NETWORK LLC
Doing business as
Iredell Endocrinology
Practice address
143 Joe Knox Ave
Suite 100
Mooresville, NC 28117-9243
Phone
(704) 878-4500
Fax
(704) 872-7924
NPI assigned
Apr 29, 2008
Last updated
May 12, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
IREDELL PHYSICIAN NETWORK LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 12, 2010

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

Authorized official

Name
Ms. Anna Purcell
Title
Director
Phone
(704) 878-4569

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 9400602 NC Primary

Addresses

Primary practice location

143 Joe Knox Ave
Suite 100
Mooresville, NC 28117-9243

Mailing address

PO Box 25867
Winston Salem, NC 27114-5867
Phone (704) 878-4500

Other identifiers 1

IdentifierTypeStateIssuer
5950095MedicaidNC

Other names 1

  • Iredell Endocrinology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090219000651 NC Part B Supplier - Clinic/Group Practice 0749345007 Receives reassigned benefits from 139 practitioners
39 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Statesville, NC; Taylorsville, NC; Troutman, NC; Hickory, NC; Harmony, NC; Mooresville, NC

Other NPIs on the same Medicare enrollment 39

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 39

National Provider Directory

National Provider Directory
Part of
Iredell Internal Medicine

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1209427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1273622400000",
    "number": "1003081175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25867",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271145867",
            "telephone_number": "704-878-4500",
            "fax_number": "704-872-7924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "143 JOE KNOX AVE",
            "address_2": "SUITE 100",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281179243",
            "telephone_number": "704-878-4500",
            "fax_number": "704-872-7924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IREDELL PHYSICIAN NETWORK LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IREDELL PHYSICIAN NETWORK LLC",
        "enumeration_date": "2008-04-29",
        "last_updated": "2010-05-12",
        "status": "A",
        "authorized_official_last_name": "PURCELL",
        "authorized_official_first_name": "ANNA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "704-878-4569",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NC",
            "license": "9400602",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5950095",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Iredell Endocrinology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mooresville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2010; 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.