NPIMap

Organization Active NPI

Iredell Physician Network LLC

  • Family Medicine Physician
  • Statesville, NC
National Provider Identifier
1487840427
Registry record updated May 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
96-00787 Issued in NC
Legal business name
IREDELL PHYSICIAN NETWORK LLC
Practice address
774 Hartness Rd
Statesville, NC 28677-3376
Phone
(704) 924-7992
Fax
(704) 924-7950
NPI assigned
Sep 24, 2007
Organization subpart
Yes
Parent organization
IREDELL PHYSICIAN NETWORK LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 12, 2010

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

Authorized official

Name
Ms. Anna Purcell
Title
Director
Phone
(704) 878-4569

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 96-00787 NC Primary

Addresses

Primary practice location

774 Hartness Rd
Statesville, NC 28677-3376

Mailing address

PO Box 25867
Winston Salem, NC 27114-5867
Phone (704) 924-7992

Other identifiers 1

IdentifierTypeStateIssuer
5908193MedicaidNC

Other names 1

  • Young Family Practice 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
Part of
Iredell Physician Network

Member of 1

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

NPI Registry JSON

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

{
    "created_epoch": "1190592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1273622400000",
    "number": "1487840427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25867",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271145867",
            "telephone_number": "704-924-7992",
            "fax_number": "704-924-7950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "774 HARTNESS RD",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286773376",
            "telephone_number": "704-924-7992",
            "fax_number": "704-924-7950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IREDELL PHYSICIAN NETWORK LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IREDELL PHYSICIAN NETWORK LLC",
        "enumeration_date": "2007-09-24",
        "last_updated": "2010-05-12",
        "status": "A",
        "authorized_official_last_name": "PURCELL",
        "authorized_official_first_name": "ANNA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "704-878-4569",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "96-00787",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5908193",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Young Family Practice",
            "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 May 12, 2010; 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.