NPIMap

Organization Active NPI

Ivy Creek Specialty Care

Doing business as Ivy Creek Anesthesia

  • Anesthesiology Physician
  • Wetumpka, AL
National Provider Identifier
1467069070
Registry record updated Oct 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
IVY CREEK SPECIALTY CARE
Doing business as
Ivy Creek Anesthesia
Practice address
500 Hospital Dr
Wetumpka, AL 36092-1625
Phone
(334) 283-2542
Fax
(342) 832-3773
NPI assigned
Sep 28, 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
Mr. Michael D Bruce, OWNER / CEO
Title
Ceo & Ao
Phone
(334) 567-4311

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X NU Primary

Addresses

Primary practice location

500 Hospital Dr
Wetumpka, AL 36092-1625

Mailing address

500 Hospital Dr
Wetumpka, AL 36092-1625
Phone (334) 283-2542

Other practice location 1

201 Mariarden Rd
Dadeville, AL 36853-6251
Phone (256) 825-7821

Other names 1

  • IVY CREEK ANESTHESIA Doing business as

Electronic endpoints 2

TypeEndpointUseAffiliation
RESTful URL HIE
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
This NPI is an additional NPI on the 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

525 Hospital Dr
Ste B
Wetumpka, AL 36092
Phone (334) 567-5626

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": "1601251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602201600000",
    "number": "1467069070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 HOSPITAL DR",
            "city": "WETUMPKA",
            "state": "AL",
            "postal_code": "360921625",
            "telephone_number": "334-283-2542",
            "fax_number": "342-832-3773"
        },
        {
            "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": "334-283-2542",
            "fax_number": "342-832-3773"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "201 Mariarden Rd",
            "address_purpose": "LOCATION",
            "city": "Dadeville",
            "state": "AL",
            "postal_code": "368536251",
            "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": "2020-09-28",
        "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 & AO",
        "authorized_official_telephone_number": "334-567-4311",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OWNER / CEO"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "REST",
            "endpointTypeDescription": "RESTful URL",
            "endpoint": "HIE",
            "affiliation": "N",
            "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": "201 Mariarden Rd",
            "city": "Dadeville",
            "state": "AL",
            "country_code": "US",
            "postal_code": "368536251",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "IVY CREEK ANESTHESIA",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "IVY CREEK ANESTHESIA",
            "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.