NPIMap

Organization Active NPI

Ivycreek of Elmore LLC

  • Basic Emergency Medical Technician
  • Wetumpka, AL
National Provider Identifier
1205034428
Registry record updated Apr 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Basic Emergency Medical TechnicianTaxonomy code 146N00000X
Legal business name
IVYCREEK OF ELMORE LLC
Practice address
500 Hospital Dr
Wetumpka, AL 36092-1625
Phone
(334) 567-4311
Fax
(334) 567-4312
NPI assigned
Jul 10, 2007
Organization subpart
Yes
Parent organization
IVYCREEK OF ELMORE LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 5, 2022

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)CodeLicenseStatePrimary
Basic Emergency Medical TechnicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 146N00000X H2601 AL
Basic Emergency Medical TechnicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 146N00000X Primary

Addresses

Primary practice location

500 Hospital Dr
Wetumpka, AL 36092-1625

Mailing address

PO Box 130
Wetumpka, AL 36092-0003
Phone (334) 567-4311

Other identifiers 2

IdentifierTypeStateIssuer
529905190MedicaidAL
01D680545OtherALCLIA

Other names 1

  • ELMORE COMMUNITY HOSPITAL Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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.

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Dr Seema Maheshwari8 organizations share this tax ID, including this one
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.

Locations

4412 Hogan Rd
Deatsville, AL 36022
Phone (334) 514-4851

Practitioners & affiliated clinicians

Practitioners 67

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 67

NPI Registry JSON

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

{
    "created_epoch": "1184025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649116800000",
    "number": "1205034428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130",
            "city": "WETUMPKA",
            "state": "AL",
            "postal_code": "360920003",
            "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": "IVYCREEK OF ELMORE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IVYCREEK OF ELMORE LLC",
        "enumeration_date": "2007-07-10",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "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": "146N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Emergency Medical Technician, Basic",
            "state": "AL",
            "license": "H2601",
            "primary": false
        },
        {
            "code": "146N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Emergency Medical Technician, Basic",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529905190",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "01D680545",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ELMORE COMMUNITY HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ELMORE COMMUNITY 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 Apr 5, 2022; 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.