NPIMap

Organization Active NPI

Ivycreek of Elmore LLC

Doing business as River Region Family Medicine

  • Rural Health Clinic/Center
  • Wetumpka, AL
National Provider Identifier
1366565152
Registry record updated Oct 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
IVYCREEK OF ELMORE LLC
Doing business as
River Region Family Medicine
Practice address
41 Cambridge CT
Wetumpka, AL 36093-1261
Phone
(334) 567-3309
Fax
(334) 567-3361
NPI assigned
Apr 9, 2007
Last updated
Oct 1, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
IVYCREEK OF ELMORE LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 1, 2012

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

Authorized official

Name
Mr. Michael D Bruce
Title
Ceo
Phone
(334) 567-4311

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Preferred Provider Organization 305R00000X 22736 AL

Addresses

Primary practice location

41 Cambridge CT
Wetumpka, AL 36093-1261

Mailing address

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

Other names 1

  • RIVER REGION FAMILY MEDICINE 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
Part of
Marcial Mendrz MD

NPI Registry JSON

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

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349049600000",
    "number": "1366565152",
    "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": "41 CAMBRIDGE CT",
            "city": "WETUMPKA",
            "state": "AL",
            "postal_code": "360931261",
            "telephone_number": "334-567-3309",
            "fax_number": "334-567-3361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVYCREEK OF ELMORE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IVYCREEK OF ELMORE LLC",
        "enumeration_date": "2007-04-09",
        "last_updated": "2012-10-01",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "AL",
            "license": "22736",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RIVER REGION FAMILY MEDICINE",
            "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 Oct 1, 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.

Verify at the official NPI Registry.