Ivycreek of Elmore LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

IVYCREEK OF ELMORE LLC

Practice address

41 Cambridge CT
Wetumpka, AL 36093-1261

Phone

(334) 567-3309

Fax

(334) 567-3361

NPI assigned

Apr 9, 2007

Organization subpart

Yes

Parent organization

IVYCREEK OF ELMORE LLCAs reported in NPPES

Name

Mr. Michael D Bruce

Title

Ceo

Phone

(334) 567-4311

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Ivy Creek Home Health of Elmore, LLC

  • Home Health Agency
  • Wetumpka, AL
  • NPI 1255533642

  O20051027001031

  Same enrollment
• Ivy Creek of Elmore LLC

  • General Acute Care Hospital
  • Wetumpka, AL
  • NPI 1396031092

  O20051027001031

  Same enrollment
• Ivy Creek of Elmore LLC

  • Internal Medicine Physician
  • Wetumpka, AL
  • NPI 1467975581

  O20051027001031

  Same enrollment
• Ivy Creek of Elmore LLC

  • General Acute Care Hospital
  • Wetumpka, AL
  • NPI 1790093029

  O20051027001031

  Same enrollment
• Ivy Creek of Elmore, LLC

  • Preferred Provider Organization
  • Wetumpka, AL
  • NPI 1093838880

  O20051027001031

  Same enrollment
• Ivy Creek of Elmore, LLC

  • Certified Registered Nurse Anesthetist
  • Wetumpka, AL
  • NPI 1144547712

  O20051027001031

  Same enrollment
• Ivy Creek of Elmore, LLC

  • Surgery Physician
  • Wetumpka, AL
  • NPI 1154642684

  O20051027001031

  Same enrollment
• Ivy Creek of Elmore, LLC

  • Rural Health Clinic/Center
  • Wetumpka, AL
  • NPI 1508480633

  O20051027001031

  Same enrollment
• Ivy Creek of Elmore, LLC

  • Rural Health Clinic/Center
  • Tallassee, AL
  • NPI 1558868323

  O20051027001031

  Same enrollment
• Ivy Creek of Elmore, LLC

  • Rural Health Clinic/Center
  • Deatsville, AL
  • NPI 1578060349

  O20051027001031

  Same enrollment
• Ivy Creek of Elmore, LLC

  • General Acute Care Hospital
  • Wetumpka, AL
  • NPI 1588795942

  O20051027001031

  Same enrollment
• Ivy Creek of Elmore, LLC

  • Wound Care Registered Nurse
  • Wetumpka, AL
  • NPI 1679204838

  O20051027001031

  Same enrollment

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

Part of

Dr Seema Maheshwari

• RIVER REGION FAMILY MEDICINE Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 1, 2012.

{
    "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "540003434",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RIVER REGION FAMILY MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ivy Creek of Elmore, LLC
• Ivy Creek Palliative Care, LLC
• Ivy Creek Specialty Care
• Ivy Creek Specialty Care
• Ivycreek of Elmore LLC
• Ivycreek of Elmore LLC
• Jackson Clinic Multispecialty Wetumpka
• Jackson Hospital and Clinic Inc.
• Jackson Hospital and Clinic, Inc
• Sabrina Jackson, OWNER

• All providers in Wetumpka, AL
• Rural Health Clinic/Center in Alabama

• 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.