NPIMap

Organization Active NPI

Iredell Physician Network, LLC

Doing business as Ruby Grimm, M.D.

  • Hematology & Oncology Physician
  • Statesville, NC
National Provider Identifier
1477805166
Registry record updated Apr 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
Legal business name
IREDELL PHYSICIAN NETWORK, LLC
Doing business as
Ruby Grimm, M.D.
Practice address
738 Bryant St
Statesville, NC 28677-4189
Phone
(704) 873-2219
Fax
(704) 873-1379
NPI assigned
Oct 5, 2012
Last updated
Apr 5, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2021

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

Authorized official

Name
Kathryn Heles
Title
Credentialing
Phone
(866) 340-0396

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RH0003X Primary

Addresses

Primary practice location

738 Bryant St
Statesville, NC 28677-4189

Mailing address

PO Box 896199
Charlotte, NC 28289-6199
Phone (833) 936-1364

Other names 1

  • Ruby Grimm, M.D. Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090219000651 NC Part B Supplier - Clinic/Group Practice 0749345007 Receives reassigned benefits from 139 practitioners
39 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Statesville, NC; Taylorsville, NC; Troutman, NC; Hickory, NC; Harmony, NC; Mooresville, NC

Other NPIs on the same Medicare enrollment 39

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

View all 39

National Provider Directory

National Provider Directory
Tax ID family
Iredell Internal Medicine23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

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

View all 22

Locations

542 Brookdale Dr
Statesville, NC 28677
Phone (704) 380-6940

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1349395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617580800000",
    "number": "1477805166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 896199",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282896199",
            "telephone_number": "833-936-1364",
            "fax_number": "605-942-7505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "738 BRYANT ST",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286774189",
            "telephone_number": "704-873-2219",
            "fax_number": "704-873-1379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IREDELL PHYSICIAN NETWORK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-05",
        "last_updated": "2021-04-05",
        "certification_date": "2021-04-05",
        "status": "A",
        "authorized_official_last_name": "HELES",
        "authorized_official_first_name": "KATHRYN",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "866-340-0396"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ruby Grimm, M.D.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ruby Grimm, M.D.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Statesville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2021; 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.