NPIMap

Organization Active NPI

Ivy Creek Family Care of Lake Martin

Doing business as Ivy Creek Urgent Care

  • Urgent Care Clinic/Center
  • Dadeville, AL
National Provider Identifier
1609572890
Registry record updated Mar 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
IVY CREEK FAMILY CARE OF LAKE MARTIN
Doing business as
Ivy Creek Urgent Care
Practice address
5958 Highway 49 S Unit K
Dadeville, AL 36853-6771
Phone
(256) 825-7821
NPI assigned
Jan 31, 2023
Last updated
Mar 20, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2025

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

Authorized official

Name
Jade Lane
Title
Credentialing Manager
Phone
(334) 567-4311

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X
Urgent Care Clinic/Center 261QU0200X Primary

Addresses

Primary practice location

5958 Highway 49 S Unit K
Dadeville, AL 36853-6771

Mailing address

PO Box 130
Wetumpka, AL 36092-0003
Phone (334) 514-3821

Other names 1

  • IVY CREEK URGENT CARE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230501000230 AL Part B Supplier - Clinic/Group Practice 6103281977 Receives reassigned benefits from 118 practitioners
Practice locations: Dadeville, AL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 120

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 120

NPI Registry JSON

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

{
    "created_epoch": "1675123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742428800000",
    "number": "1609572890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130",
            "city": "WETUMPKA",
            "state": "AL",
            "postal_code": "360920003",
            "telephone_number": "334-514-3821",
            "fax_number": "334-514-3686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5958 HIGHWAY 49 S UNIT K",
            "city": "DADEVILLE",
            "state": "AL",
            "postal_code": "368536771",
            "telephone_number": "256-825-7821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVY CREEK FAMILY CARE OF LAKE MARTIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-31",
        "last_updated": "2025-03-20",
        "certification_date": "2025-03-20",
        "status": "A",
        "authorized_official_last_name": "LANE",
        "authorized_official_first_name": "JADE",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "334-567-4311"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IVY CREEK URGENT CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dadeville, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2025; 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.