NPIMap

Organization Active NPI

Iredell Physician Network LLC

Doing business as Iredell Ambulatory Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Statesville, NC
National Provider Identifier
1578073631
Registry record updated May 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
IREDELL PHYSICIAN NETWORK LLC
Doing business as
Iredell Ambulatory Surgery Center
Practice address
701 Bryant St
Statesville, NC 28677-4142
Phone
(704) 380-2711
Fax
(704) 380-2747
NPI assigned
Oct 3, 2017
Last updated
May 1, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
IREDELL PHYSICIAN NETWORK LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 1, 2024

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

Authorized official

Name
Joanie M Cochran
Title
Credentialing Coordinator
Phone
(336) 306-9755

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

701 Bryant St
Statesville, NC 28677-4142

Mailing address

PO Box 896199
Charlotte, NC 28289-4107
Phone (446) 520-6118

Other names 1

  • Iredell Ambulatory Surgery Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

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
O20180813003000 NC Part B Supplier - Ambulatory Surgical Center 0749345007 Practice locations: Statesville, NC

Other NPIs with the same Medicare PAC ID 4

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

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
34D2081124Iredell Ambulatory Surgery Center701 Bryant Street, Statesville, NC 28677Certificate of waiverJul 20, 2028

National Provider Directory

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

Other organizations with this tax ID 22

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

View all 22

Practitioners & affiliated clinicians

Practitioners 1

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": "1506988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714521600000",
    "number": "1578073631",
    "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": "282894107",
            "telephone_number": "446-520-6118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 BRYANT ST",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286774142",
            "telephone_number": "704-380-2711",
            "fax_number": "704-380-2747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IREDELL PHYSICIAN NETWORK LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IREDELL PHYSICIAN NETWORK LLC",
        "enumeration_date": "2017-10-03",
        "last_updated": "2024-05-01",
        "certification_date": "2024-05-01",
        "status": "A",
        "authorized_official_last_name": "COCHRAN",
        "authorized_official_first_name": "JOANIE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "336-306-9755"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Iredell Ambulatory Surgery Center",
            "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 1, 2024; 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.