NPIMap

Organization Active NPI

Hospice of Iredell County, Inc

  • Community Based Hospice Care Agency
  • Statesville, NC
National Provider Identifier
1336243997
Registry record updated Dec 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
HOSPICE OF IREDELL COUNTY, INC
Practice address
2347 Simonton Rd
Statesville, NC 28625-8246
Phone
(704) 873-4719
Fax
(704) 872-1810
NPI assigned
Sep 12, 2006
Last updated
Dec 13, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2023

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

Authorized official

Name
Michael Smith
Title
President/Ceo
Phone
(704) 873-4719

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

2347 Simonton Rd
Statesville, NC 28625-8246

Mailing address

2347 Simonton Rd
Statesville, NC 28625-8246
Phone (704) 873-4719

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20051007000835 NC Part B Supplier - Clinic/Group Practice 2961427018 Receives reassigned benefits from 24 practitioners
Practice locations: Statesville, NC; Mooresville, NC
O20090416000294 NC Part A Provider - Hospice 2961427018 Practice locations: Mooresville, NC; Statesville, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336243997. Details of each certification follow.

Hospice certification: CCN 341517

Legal name
HOSPICE OF IREDELL COUNTY INC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Oct 7, 1987
Last certification
Oct 13, 2005
Ownership / control type
Non-Profit - Private
Organization structure
OtherProprietary
Incorporated
Nov 19, 1982 in NC
Enrollment address
2347 Simonton Rd
Statesville, NC 28625-8246

Care Compare: Hospice

Medicare Care Compare
Listed as
Hospice of Iredell County, IncCCN 341517 · All quality measures
Ownership
Non-Profit
Certified
Oct 7, 1987
Medicare certification status
ActiveFrom the Provider of Services file

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
34D0877710Hospice of Iredell County Inc2347 Simonton Rd, Statesville, NC 28625Certificate of waiverOct 6, 2027

National Provider Directory

National Provider Directory

Locations

1325 Mecklenburg Hwy
Mooresville, NC 28115
Phone (980) 759-1970

610 E Center Ave
Mooresville, NC 28115
Phone (704) 660-1020

2341 Simonton Rd
Statesville, NC 28625
Phone (704) 761-2400

2347 Simonton Rd
Statesville, NC 28625
Phone (704) 873-4719

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Michael Smith Individual Corporate DirectorPresident/Ceo Jan 3, 2022
Maurice Lunsford Individual Corporate Officer Mar 17, 2014
Edwin Hunter Individual Corporate Officer Mar 17, 2014
Catherine Kelley Carnes Individual Corporate Director Nov 1, 2020
Betsy Yarborough Individual Corporate Officer Oct 31, 2007
Corporate Director Oct 31, 2007
Brad Dancy Individual W-2 Managing Employee Jul 31, 2013
Phil Smith Individual Corporate Officer Mar 17, 2014

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 31

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.

View all 31

Affiliated clinicians 42

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 42

NPI Registry JSON

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

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702425600000",
    "number": "1336243997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2347 SIMONTON RD",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286258246",
            "telephone_number": "704-873-4719",
            "fax_number": "704-872-1810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2347 SIMONTON RD",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286258246",
            "telephone_number": "704-873-4719",
            "fax_number": "704-872-1810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPICE OF IREDELL COUNTY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-12",
        "last_updated": "2023-12-13",
        "certification_date": "2023-12-13",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "704-873-4719"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Statesville, NC

Sources for this page

Verify at the official NPI Registry.