NPIMap

Organization Active NPI

Iredell Physician Network LLC

  • Rural Health Clinic/Center
  • Taylorsville, NC
National Provider Identifier
1124402946
Registry record updated Apr 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
IREDELL PHYSICIAN NETWORK LLC
Practice address
1668 NC Highway 16 S
Taylorsville, NC 28681-6285
Phone
(828) 632-9736
Fax
(828) 632-9544
NPI assigned
Jul 10, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2021

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

Authorized official

Name
Kathryn Heles
Title
Credentialing
Phone
(866) 340-0396

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1668 NC Highway 16 S
Taylorsville, NC 28681-6285

Mailing address

PO Box 896199
Charlotte, NC 28289-6199
Phone (833) 936-1364

Other names 1

  • Family Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150924001221 NC Part A Provider - Rural Health Clinic 0749345007 Practice locations: Taylorsville, NC

Rural health clinic certification: CCN 348932

Legal name
IREDELL PHYSICIAN NETWORK LLC
Doing business as
FAMILY CARE CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 19, 1999
Last certification
Sep 14, 2021
Ownership / control type
2B
Most recent change of ownership
Sep 1, 2015 (1 total)
Organization structure
LLCNon-profit
Incorporated
Dec 5, 2008 in NC
Enrollment address
1668 NC Highway 16 S
Taylorsville, NC 28681-6285

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D0679096Ipn Dba Family Care Center1668 NC Highway 16 South, Taylorsville, NC 28681AccreditationDec 22, 2027

National Provider Directory

National Provider Directory
Tax ID family
Iredell Physician Network23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Iredell Memorial Hospital Incorporated Organization, Statesville, NC Non-profit 5% Or Greater Direct Ownership Interest Sep 1, 2015 100%
Joel Ray Inman Individual W-2 Managing EmployeeMedical Director Sep 1, 2015
Gary E Smith Individual Corporate OfficerVP Finance/Cfo Sep 19, 2013
Edward Rush Individual Corporate OfficerAdministrator/Ceo Sep 1, 2015

Owners & managing parties with NPI records 6

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1436486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617580800000",
    "number": "1124402946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 896199",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282896199",
            "telephone_number": "833-936-1364",
            "fax_number": "605-942-7505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1668 NC HIGHWAY 16 S",
            "city": "TAYLORSVILLE",
            "state": "NC",
            "postal_code": "286816285",
            "telephone_number": "828-632-9736",
            "fax_number": "828-632-9544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IREDELL PHYSICIAN NETWORK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-10",
        "last_updated": "2021-04-05",
        "certification_date": "2021-04-05",
        "status": "A",
        "authorized_official_last_name": "HELES",
        "authorized_official_first_name": "KATHRYN",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "866-340-0396"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Taylorsville, NC

Sources for this page

Verify at the official NPI Registry.