NPIMap

Organization Active NPI

Ivy Creek of Elmore LLC

  • Internal Medicine Physician
  • Wetumpka, AL
National Provider Identifier
1467975581
Registry record updated Mar 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
IVY CREEK OF ELMORE LLC
Practice address
807 Jackson Trace Rd
Wetumpka, AL 36092-1504
Phone
(334) 358-3777
NPI assigned
Jul 20, 2017
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Lynda Gayle Dozier-McCormick
Title
Billing Manager
Phone
(334) 514-3848

Other NPIs on the same Medicare enrollment 14

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

View all 14

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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

National Provider Directory

National Provider Directory
Tax ID family
Dr Seema Maheshwari8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

807 Jackson Trace Rd
Wetumpka, AL 36092
Phone (334) 514-2002

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

NPPES NPI Registry

Primary practice location

807 Jackson Trace Rd
Wetumpka, AL 36092-1504

Mailing address

807 Jackson Trace Rd
Wetumpka, AL 36092-1504

Other names 1

NPPES NPI Registry
  • IVY CREEK INTERNAL MEDICINE Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 29, 2018.

{
    "created_epoch": "1500508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522281600000",
    "number": "1467975581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "807 JACKSON TRACE RD",
            "city": "WETUMPKA",
            "state": "AL",
            "postal_code": "360921504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "807 JACKSON TRACE RD",
            "city": "WETUMPKA",
            "state": "AL",
            "postal_code": "360921504",
            "telephone_number": "334-358-3777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVY CREEK OF ELMORE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-20",
        "last_updated": "2018-03-29",
        "status": "A",
        "authorized_official_last_name": "DOZIER-MCCORMICK",
        "authorized_official_first_name": "LYNDA",
        "authorized_official_middle_name": "GAYLE",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "334-514-3848"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IVY CREEK INTERNAL MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "IVY CREEK INTERNAL 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 Mar 29, 2018; 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.