NPIMap

Organization Active NPI

Ivy Creek Specialty Care

Doing business as Ivy Creek Anesthesia Lake Martin

  • Emergency Medical Services (Emergency Medicine) Physician
  • Wetumpka, AL
National Provider Identifier
1396342184
Registry record updated Oct 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
Legal business name
IVY CREEK SPECIALTY CARE
Doing business as
Ivy Creek Anesthesia Lake Martin
Ivy Creek ER
Practice address
500 Hospital Dr
Wetumpka, AL 36092-1625
Phone
(334) 567-4311
Fax
(334) 514-3686
NPI assigned
Oct 5, 2020
Last updated
Oct 9, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2020

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

Authorized official

Name
Michael D Bruce, CEO
Title
Ceo
Phone
(334) 567-4311

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207PE0004X 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 practice location 1

201 Mariarden Rd
Dadeville, AL 36853-6244
Phone (256) 825-7821

Other names 2

  • IVY CREEK ANESTHESIA LAKE MARTIN Doing business as
  • Ivy Creek ER Doing business as

Electronic endpoints 2

TypeEndpointUseAffiliation
RESTful URL DIRECT
RESTful URL Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201209002925 AL Part B Supplier - Clinic/Group Practice 2264844638 Receives reassigned benefits from 24 practitioners
1 other NPI on this enrollment
Practice locations: Dadeville, AL; Wetumpka, AL

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Ivy Creek Anesthesia3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

500 Hospital Dr
Wetumpka, AL 36092
Phone (334) 283-2542

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1601856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602201600000",
    "number": "1396342184",
    "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": "334-514-3686"
        },
        {
            "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": "334-514-3686"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "201 Mariarden Rd",
            "address_purpose": "LOCATION",
            "city": "Dadeville",
            "state": "AL",
            "postal_code": "368536244",
            "country_code": "US",
            "telephone_number": "256-825-7821",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "IVY CREEK SPECIALTY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-05",
        "last_updated": "2020-10-09",
        "certification_date": "2020-10-09",
        "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_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "REST",
            "endpointTypeDescription": "RESTful URL",
            "endpoint": "DIRECT",
            "affiliation": "N",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "500 Hospital Dr",
            "city": "Wetumpka",
            "state": "AL",
            "country_code": "US",
            "postal_code": "360921625",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "REST",
            "endpointTypeDescription": "RESTful URL",
            "endpoint": "Direct",
            "affiliation": "N",
            "address_1": "500 Hospital Dr",
            "city": "Wetumpka",
            "state": "AL",
            "country_code": "US",
            "postal_code": "360921625",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "IVY CREEK ANESTHESIA LAKE MARTIN",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ivy Creek ER",
            "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 9, 2020; 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.