NPIMap

Organization Active NPI

Ivy Creek of Elmore, LLC

Doing business as Ivy Creek Wound Care

  • Wound Care Registered Nurse
  • Wetumpka, AL
National Provider Identifier
1679204838
Registry record updated Jun 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Wound Care Registered NurseTaxonomy code 163WW0000X
Legal business name
IVY CREEK OF ELMORE, LLC
Doing business as
Ivy Creek Wound Care
Practice address
500 Hospital Dr Ste C
Wetumpka, AL 36092-1625
Phone
(334) 567-4311
Fax
(334) 514-3686
NPI assigned
Jun 20, 2022
Last updated
Jun 20, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
IVY CREEK OF ELMORE, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 20, 2022

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

Authorized official

Name
Michael D Bruce
Title
Ceo
Phone
(334) 567-4311

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Wound Care Registered Nurse 163WW0000X Primary

Addresses

Primary practice location

500 Hospital Dr Ste C
Wetumpka, AL 36092-1625

Mailing address

PO Box 130
Wetumpka, AL 36092-0003
Phone (334) 283-2542

Other names 1

  • IVY CREEK WOUND CARE Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
RESTful URL OTHER IVY CREEK OF ELMORE, LLC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051027001031 AL Part B Supplier - Clinic/Group Practice 8426075508 Receives reassigned benefits from 183 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Deatsville, AL; Tallassee, AL; Wetumpka, AL

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Elmore Comm Rural HLTH Clin8 organizations share this tax ID, including this one
Part of
Elmore Comm Rural HLTH Clin

Other organizations with this tax ID 7

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

Locations

500 Hospital Dr
Ste C
Wetumpka, AL 36092
Phone (334) 567-4311

Practitioners & affiliated clinicians

Practitioners 2

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": "1655683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655683200000",
    "number": "1679204838",
    "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": "334-283-2542",
            "fax_number": "334-514-3686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 HOSPITAL DR STE C",
            "city": "WETUMPKA",
            "state": "AL",
            "postal_code": "360921625",
            "telephone_number": "334-567-4311",
            "fax_number": "334-514-3686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVY CREEK OF ELMORE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IVY CREEK OF ELMORE, LLC",
        "enumeration_date": "2022-06-20",
        "last_updated": "2022-06-20",
        "certification_date": "2022-06-20",
        "status": "A",
        "authorized_official_last_name": "BRUCE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "334-567-4311"
    },
    "taxonomies": [
        {
            "code": "163WW0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Wound Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "REST",
            "endpointTypeDescription": "RESTful URL",
            "endpoint": "OTHER",
            "affiliation": "Y",
            "affiliationName": "IVY CREEK OF ELMORE, LLC",
            "address_1": "500 Hospital Dr Ste C",
            "city": "Wetumpka",
            "state": "AL",
            "country_code": "US",
            "postal_code": "360921625",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "IVY CREEK WOUND CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wetumpka, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2022; 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.