Iredell Surgical Associates, LLP

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

IREDELL SURGICAL ASSOCIATES, LLP

Doing business as

Iredell Surgical Center

Practice address

1720 Davie Ave
Statesville, NC 28677-3522

Phone

(704) 871-0081

Fax

(704) 871-0086

NPI assigned

Aug 30, 2006

Last updated

Jan 29, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Mary Elkins

Title

Administrator

Phone

(803) 448-1022

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Iredell Surgical Center Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Listed as

Iredell Surgical Associates LLPCCN 34C0001032

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 3

Organizations this organization is a member of, according to the National Provider Directory.

• Carolinas Physicians Network, Inc.

  dba Greater Carolinas Womens Center

  • Obstetrics & Gynecology Physician
  • Charlotte, NC
  • NPI 1679896054

  Member Of

  NPD member
• Iredell Memorial Hospital Incorporated

  dba Iredell Home Health

  • Home Health Agency
  • Statesville, NC
  • NPI 1215986260

  Member Of

  NPD member
• The Charlotte-Mecklenburg Hospital Authority

  dba Atrium Health Primary Care and Integrative Medicine

  • Internal Medicine Physician
  • Concord, NC
  • NPI 1023445517

  Member Of

  NPD member

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706486400000",
    "number": "1437269800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 DAVIE AVE",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286773522",
            "telephone_number": "704-871-0081",
            "fax_number": "704-871-0086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 DAVIE AVE",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286773522",
            "telephone_number": "704-871-0081",
            "fax_number": "704-871-0086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IREDELL SURGICAL ASSOCIATES, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2024-01-29",
        "certification_date": "2024-01-29",
        "status": "A",
        "authorized_official_last_name": "ELKINS",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "803-448-1022",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3409866",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMB SURG CTR BC/BS #",
            "identifier": "00650",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Iredell Surgical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Iredell Physician Network, LLC (Ruby Grimm, M.D.)
• Iredell Physician Network, LLC (Iredell Cardiology)
• Iredell Physician Network, LLC (Iredell Pain Management)
• Iredell Physician Network, LLC (Iredell Pediatrics)
• Iredell Radiology Associates PA
• Iredell-Statesville Schools
• Iredell-Statesville Schools
• Daniela Getuza Isfan, M.D.
• Jarrett Isler
• Andrea Evbu Iyekepolo

• Ambulatory Surgical Clinic/Center in Statesville, NC
• Providers in Statesville, NC by specialty
• Ambulatory Surgical Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.