NPIMap

Organization Active NPI

Iredell Physician Network LLC

  • Family Medicine Physician
  • Harmony, NC
National Provider Identifier
1639318751
Registry record updated May 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
IREDELL PHYSICIAN NETWORK LLC
Practice address
955 West Memorial Highway
Harmony, NC 28634-9352
Phone
(704) 878-4569
NPI assigned
Feb 12, 2009
Organization subpart
Yes
Parent organization
IREDELL PHYSICIAN NETWORK LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 17, 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 Primary

Addresses

Primary practice location

955 West Memorial Highway
Harmony, NC 28634-9352

Mailing address

PO Box 25867
Winston Salem, NC 27114-5867

Other identifiers 1

IdentifierTypeStateIssuer
5911498MedicaidNC

Other names 1

  • Union Grove 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

Locations

955 W Memorial Hwy
Harmony, NC 28634
Phone (336) 701-3237

NPI Registry JSON

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

{
    "created_epoch": "1234396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274054400000",
    "number": "1639318751",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "955 WEST MEMORIAL HIGHWAY",
            "city": "HARMONY",
            "state": "NC",
            "postal_code": "286349352",
            "telephone_number": "704-878-4569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IREDELL PHYSICIAN NETWORK LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IREDELL PHYSICIAN NETWORK LLC",
        "enumeration_date": "2009-02-12",
        "last_updated": "2010-05-17",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5911498",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Union Grove Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Harmony, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 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.