NPIMap

Organization Active NPI

Iredell Physician Network LLC

  • Vascular Surgery Physician
  • Statesville, NC
National Provider Identifier
1801475165
Registry record updated Apr 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
IREDELL PHYSICIAN NETWORK LLC
Practice address
770 Hartness Rd
Statesville, NC 28677-3376
Phone
(704) 883-3378
Fax
(704) 883-3228
NPI assigned
Apr 5, 2021
Organization subpart
Yes
Parent organization
IREDELL PHYSICIAN NETWORK LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 5, 2021

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

Authorized official

Name
Kathryn Heles
Title
Credentialing
Phone
(866) 340-0396

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2086S0129X Primary

Addresses

Primary practice location

770 Hartness Rd
Statesville, NC 28677-3376

Mailing address

PO Box 896199
Charlotte, NC 28289-6199
Phone (833) 936-1364

Other names 1

  • Iredell Vascular Clinic 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

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
34D2228737Iredell Vascular Clinic770 Hartness Road, Statesville, NC 28677Certificate of waiverJun 29, 2027

National Provider Directory

National Provider Directory
Tax ID family
Iredell Physician Network23 organizations share this tax ID, including this one
Part of
Iredell Physician Network

Other organizations with this tax ID 22

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

View all 22

Locations

770 Hartness Rd
Statesville, NC 28677
Phone (704) 873-1851

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1617580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617580800000",
    "number": "1801475165",
    "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": "282896199",
            "telephone_number": "833-936-1364",
            "fax_number": "605-942-7505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "770 HARTNESS RD",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286773376",
            "telephone_number": "704-883-3378",
            "fax_number": "704-883-3228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IREDELL PHYSICIAN NETWORK LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IREDELL PHYSICIAN NETWORK LLC",
        "enumeration_date": "2021-04-05",
        "last_updated": "2021-04-05",
        "certification_date": "2021-04-05",
        "status": "A",
        "authorized_official_last_name": "HELES",
        "authorized_official_first_name": "KATHRYN",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "866-340-0396"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Iredell Vascular Clinic",
            "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 Apr 5, 2021; 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.