NPIMap

Organization Active NPI

Iredell Memorial Hospital, Incorporated

Doing business as IMH Professional CRNA

  • General Acute Care Hospital
  • Statesville, NC
National Provider Identifier
1548230204
Registry record updated Aug 18, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
IREDELL MEMORIAL HOSPITAL, INCORPORATED
Doing business as
IMH Professional CRNA
Practice address
557 Brookdale Dr
Statesville, NC 28677
Phone
(704) 873-5661
Fax
(704) 878-4611
NPI assigned
Jan 25, 2006
Last updated
Aug 18, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
IREDELL MEMORIAL HOSPITAL, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 18, 2010

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

Authorized official

Name
Mr. Ed Rush
Title
President
Phone
(704) 873-5661

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X NU Primary

Addresses

Primary practice location

557 Brookdale Dr
Statesville, NC 28677

Mailing address

557 Brookdale Dr
Statesville, NC 28677
Phone (704) 873-5661

Other identifiers 1

IdentifierTypeStateIssuer
8000167MedicaidNC

Other names 1

  • IMH Professional CRNA Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040305000537 NC Part B Supplier - Clinic/Group Practice 0648175927 Receives reassigned benefits from 50 practitioners
Practice locations: Statesville, NC; Mooresville, NC

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Imh Professional Rad11 organizations share this tax ID, including this one
Part of
Imh Professional Rad

Other organizations with this tax ID 10

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

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Iredell Home HealthStatesville, NC, CCN 347059 Home health agency 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jan 1, 2013
Mar 15, 2021
Harmony Medical CareHarmony, NC, CCN 343919 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2015
Family Care CenterTaylorsville, NC, CCN 348932 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2015

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 52

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 52

NPI Registry JSON

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

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282089600000",
    "number": "1548230204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "557 BROOKDALE DR",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "28677",
            "telephone_number": "704-873-5661",
            "fax_number": "704-878-4611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "557 BROOKDALE DR",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "28677",
            "telephone_number": "704-873-5661",
            "fax_number": "704-878-4611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IREDELL MEMORIAL HOSPITAL, INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IREDELL MEMORIAL HOSPITAL, INC.",
        "enumeration_date": "2006-01-25",
        "last_updated": "2010-08-18",
        "status": "A",
        "authorized_official_last_name": "RUSH",
        "authorized_official_first_name": "ED",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "704-873-5661",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8000167",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IMH Professional CRNA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Statesville, NC

Sources for this page

Verify at the official NPI Registry.