NPIMap

Organization Active NPI

Iredell Physician Network LLC

  • Urgent Care Clinic/Center
  • Mooresville, NC
National Provider Identifier
1528640950
Registry record updated Jun 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
IREDELL PHYSICIAN NETWORK LLC
Practice address
653 Bluefield Rd
Ste a
Mooresville, NC 28117
Phone
(704) 883-3378
Fax
(704) 883-3228
NPI assigned
Apr 26, 2021
Organization subpart
Yes
Parent organization
IREDELL PHYSICIAN NETWORK LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 18, 2021

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

Authorized official

Name
Carla D Johnson
Title
Director of Operations
Phone
(704) 873-5661

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X Primary

Addresses

Primary practice location

653 Bluefield Rd
Ste a
Mooresville, NC 28117

Mailing address

PO Box 896199
Charlotte, NC 28289-6199
Phone (833) 963-1364

Other names 1

  • Iredell Urgent Care - Mooresville 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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2095873Iredell Mooresville Occ Med & Urgent Care653 Bluefield Road, Mooresville, NC 28117Certificate of waiverMay 12, 2027

National Provider Directory

National Provider Directory
Part of
Iredell Physician Network

NPI Registry JSON

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

{
    "created_epoch": "1619395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623974400000",
    "number": "1528640950",
    "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": "833-963-1364",
            "fax_number": "605-942-7505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "653 BLUEFIELD RD",
            "address_2": "STE A",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "28117",
            "telephone_number": "704-883-3378",
            "fax_number": "704-883-3228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IREDELL PHYSICIAN NETWORK LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IREDELL PHYSICIAN NETWORK LLC",
        "enumeration_date": "2021-04-26",
        "last_updated": "2021-06-18",
        "certification_date": "2021-06-03",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "CARLA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "704-873-5661"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Iredell Urgent Care - Mooresville",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Iredell Urgent Care - Mooresville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mooresville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2021; 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.