NPIMap

Organization Active NPI

Iredell Memorial Hospital Incorporated

Doing business as Iredell Memorial Hospital Skilled Nursing Facility

  • Skilled Nursing Facility
  • Statesville, NC
National Provider Identifier
1760462196
Registry record updated Jun 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
H0164 Issued in NC
Legal business name
IREDELL MEMORIAL HOSPITAL INCORPORATED
Doing business as
Iredell Memorial Hospital Skilled Nursing Facility
Practice address
557 Brookdale Dr
Statesville, NC 28677-4107
Phone
(704) 873-5661
Fax
(704) 878-4611
NPI assigned
Jan 20, 2006
Last updated
Jun 24, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2025

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

Authorized official

Name
Gary Smith
Title
Cfo
Phone
(704) 878-4505

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X H0164 NC Primary

Addresses

Primary practice location

557 Brookdale Dr
Statesville, NC 28677-4107

Mailing address

557 Brookdale Dr
Statesville, NC 28677-4107
Phone (704) 873-5661

Other identifiers 1

IdentifierTypeStateIssuer
3405306MedicaidNC

Other names 1

  • Iredell Memorial Hospital Skilled Nursing Facility Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120215000601 NC Part A Provider - Skilled Nursing Facility 0648175927 Practice locations: Statesville, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1760462196. Details of each certification follow.

Skilled nursing facility certification: CCN 345306

Legal name
IREDELL MEMORIAL HOSPITAL INCORPORATED
Doing business as
IREDELL MEMORIAL HOSPITAL SKILLED NURSING FACILITY
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 13, 1989
Last certification
Jan 9, 2025
Beds
48
Ownership / control type
Other Nonprofit
Organization structure
CorporationNon-profit
Incorporated
Feb 29, 1952 in NC
Enrollment address
557 Brookdale Drive
Statesville, NC 28677-4107
Nursing home name
IREDELL MEMORIAL HOSPITAL INC

Other NPIs with the same Medicare PAC ID 4

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Iredell Memorial Hospital IncCCN 345306 · All quality measures
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
5 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Other
Certified
Jul 13, 1989
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
4832.7 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

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

Other organizations with this tax ID 10

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

Locations

653 Bluefield Rd
Ste E
Mooresville, NC 28117

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Organization, Statesville, NC Corporation, Non-profit Adp of the SNF Jul 8, 2025
Individual Adp of the SNF Jul 8, 2025
Individual Adp of the SNF Jul 8, 2025
Gary E Smith Individual Corporate OfficerChief Financial Office/VP Finance Sep 19, 2013
Operational/Managerial Control Sep 19, 2023

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 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.

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1137715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750723200000",
    "number": "1760462196",
    "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": "286774107",
            "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": "286774107",
            "telephone_number": "704-873-5661",
            "fax_number": "704-878-4611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IREDELL MEMORIAL HOSPITAL INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-20",
        "last_updated": "2025-06-24",
        "certification_date": "2025-06-24",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "704-878-4505"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NC",
            "license": "H0164",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3405306",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Iredell Memorial Hospital Skilled Nursing Facility",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Statesville, NC

Sources for this page

Verify at the official NPI Registry.