Active NPI
Ivy Creek of Elmore, LLC
- Certified Registered Nurse Anesthetist
- Wetumpka, AL
National Provider Identifier
1144547712
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- Legal business name
- IVY CREEK OF ELMORE, LLC
- Practice address
- 500 Hospital Dr
Wetumpka, AL 36092-1625 - Phone
- (334) 567-4311
- Fax
- (334) 567-4312
- NPI assigned
- Apr 22, 2010
- Organization subpart
- Yes
- Parent organization
- IVY CREEK OF ELMORE, LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Michael D Bruce
- Title
- Ceo
- Phone
- (334) 567-4311
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | |||
| Certified Registered Nurse Anesthetist | 367500000X | Primary |
Addresses
Primary practice location
500 Hospital Dr
Wetumpka, AL 36092-1625
Mailing address
500 Hospital Dr
Wetumpka, AL 36092-1625
Phone (334) 567-4311
Other names 1
- Anesthesia @ Elmore Comm. Hospital
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051027001031 | AL | Part B Supplier - Clinic/Group Practice | 8426075508 |
Receives reassigned benefits from 183 practitioners 18 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Deatsville, AL; Tallassee, AL; Wetumpka, AL |
Other NPIs on the same Medicare enrollment 14
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Preferred Provider Organization
- Wetumpka, AL
- NPI 1093838880
O20051027001031
-
- Basic Emergency Medical Technician
- Wetumpka, AL
- NPI 1205034428
O20051027001031
National Provider Directory
National Provider Directory- Tax ID family
- Dr Seema Maheshwari
- Part of
- Dr Seema Maheshwari
Other organizations with this tax ID 7
Organizations that report the same tax identification number in the National Provider Directory.
-
- Rural Health Clinic/Center
- Wetumpka, AL
- NPI 1316246812
-
- Internal Medicine Physician
- Wetumpka, AL
- NPI 1467975581
-
- General Acute Care Hospital
- Wetumpka, AL
- NPI 1790093029
-
- Surgery Physician
- Wetumpka, AL
- NPI 1154642684
-
- Clinical Medical Laboratory
- Wetumpka, AL
- NPI 1265027908
-
- Wound Care Registered Nurse
- Wetumpka, AL
- NPI 1679204838
-
- Basic Emergency Medical Technician
- Wetumpka, AL
- NPI 1205034428
Practitioners & affiliated clinicians
Practitioners 6
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Certified Registered Nurse Anesthetist
- Montgomery, AL
- NPI 1770027146
Nurse Anesthetist, Certified Registered
-
- Certified Registered Nurse Anesthetist
- Opelika, AL
- NPI 1962466839
Nurse Anesthetist, Certified Registered
-
- Certified Registered Nurse Anesthetist
- Opelika, AL
- NPI 1356352843
Nurse Anesthetist, Certified Registered
-
- Certified Registered Nurse Anesthetist
- Montgomery, AL
- NPI 1679885032
Nurse Anesthetist, Certified Registered
-
- Certified Registered Nurse Anesthetist
- Montgomery, AL
- NPI 1770981334
Nurse Anesthetist, Certified Registered
-
- Certified Registered Nurse Anesthetist
- Alpharetta, GA
- NPI 1700311339
Nurse Anesthetist, Certified Registered
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1271894400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1327622400000",
"number": "1144547712",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 HOSPITAL DR",
"city": "WETUMPKA",
"state": "AL",
"postal_code": "360921625",
"telephone_number": "334-567-4311",
"fax_number": "334-567-4312"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 HOSPITAL DR",
"city": "WETUMPKA",
"state": "AL",
"postal_code": "360921625",
"telephone_number": "334-567-4311",
"fax_number": "334-567-4312"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "IVY CREEK OF ELMORE, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "IVY CREEK OF ELMORE, LLC",
"enumeration_date": "2010-04-22",
"last_updated": "2012-01-27",
"status": "A",
"authorized_official_last_name": "BRUCE",
"authorized_official_first_name": "MICHAEL",
"authorized_official_middle_name": "D",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "334-567-4311"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Anesthesiology",
"state": null,
"license": null,
"primary": false
},
{
"code": "367500000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Nurse Anesthetist, Certified Registered",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Anesthesia @ Elmore Comm. Hospital",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Wetumpka, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2012; 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.