NPIMap

Organization Active NPI

Iredell Physician Network, LLC

  • Pain Medicine Physician
  • Mooresville, NC
National Provider Identifier
1821790965
Registry record updated Jul 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
Legal business name
IREDELL PHYSICIAN NETWORK, LLC
Practice address
653 Bluefield Rd Ste H
Mooresville, NC 28117-9599
Phone
(336) 306-9755
NPI assigned
Mar 21, 2023
Organization subpart
Yes
Parent organization
IREDELL PHYSICIAN NETWORK, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 20, 2023

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

Authorized official

Name
Joanie M Cochran
Title
Credentialing Agent
Phone
(336) 306-9755

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208VP0000X Primary

Addresses

Primary practice location

653 Bluefield Rd Ste H
Mooresville, NC 28117-9599

Mailing address

653 Bluefield Rd Ste H
Mooresville, NC 28117-9599
Phone (336) 306-9755

Other names 1

  • Iredell Pain Management 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
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

Practitioners & affiliated clinicians

Practitioners 2

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": "1679356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689811200000",
    "number": "1821790965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "653 BLUEFIELD RD STE H",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281179599",
            "telephone_number": "336-306-9755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "653 BLUEFIELD RD STE H",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281179599",
            "telephone_number": "336-306-9755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IREDELL PHYSICIAN NETWORK, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IREDELL PHYSICIAN NETWORK, LLC",
        "enumeration_date": "2023-03-21",
        "last_updated": "2023-07-20",
        "certification_date": "2023-07-20",
        "status": "A",
        "authorized_official_last_name": "COCHRAN",
        "authorized_official_first_name": "JOANIE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING AGENT",
        "authorized_official_telephone_number": "336-306-9755"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Iredell Pain Management",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Iredell Pain Management",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mooresville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2023; 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.