IVY CREEK OF ELMORE, LLC (NPI# 1093838880) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093838880 |
| Entity Type | Organization |
| Organization Name | IVY CREEK OF ELMORE, LLC |
| Practice Address |
74186 Tallassee Hwy Wetumpka AL 36092-5643 |
| Mailing Address |
500 Hospital Dr Wetumpka AL 36092-1625 |
| Practice Telephone | 3345670346 |
| Practice Fax Number | 3345670855 |
| Mailing Telephone | 3345674311 |
| Mailing Fax Number | 3345673361 |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | GORDON FAULK (CEO) |
| Authorized Official Telephone | 3345674311 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 305R00000X | Preferred Provider Organization | 00011939 | AL | Managed Care Organizations |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578060349 | Ivy Creek of Elmore, LLC | Clinic/Center | 4412 Hogan Rd, Deatsville, AL 36022-3400 | 2018-04-09 |
| 1619098977 | Ivy Creek of Elmore, LLC | Specialist | 201 S Washington Street., Autaugaville, AL 36003 | 2007-04-03 |
| 1508480633 | Ivy Creek of Elmore, LLC | Family Medicine | 525 Hospital Dr, Wetumpka, AL 36092-1626 | 2020-06-04 |
| 1558868323 | Ivy Creek of Elmore, LLC | Clinic/Center | 2256 Gilmer Ave, Tallassee, AL 36078-7114 | 2018-04-09 |
| 1669733895 | Ivy Creek of Elmore, LLC | Hospitalist | 500 Hospital Dr, Wetumpka, AL 36092-1625 | 2012-06-05 |
| 1720309982 | Ivy Creek of Elmore, LLC | Physical Medicine & Rehabilitation | 500 Hospital Dr, Suite A, Wetumpka, AL 36092-1625 | 2010-06-22 |
| 1154642684 | Ivy Creek of Elmore, LLC | Surgery | 500 Hospital Dr, Suite B, Wetumpka, AL 36092-1625 | 2010-06-18 |
| 1144547712 | Ivy Creek of Elmore, LLC | Anesthesiology | 500 Hospital Dr, Wetumpka, AL 36092-1625 | 2010-04-22 |
| 1255533642 | Ivy Creek of Elmore, LLC | Home Health | 500 Hospital Drive, Wetumpka, AL 36092-1625 | 2007-06-05 |
| 1588795942 | Ivy Creek of Elmore, LLC | General Acute Care Hospital | 500 Hospital Dr, Wetumpka, AL 36092-1625 | 2007-03-08 |
| Street Address |
74186 TALLASSEE HWY |
| City | WETUMPKA |
| State | AL |
| Zip Code | 36092-5643 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093865578 | Ronaldo V Dejesus, Md, PC | Internal Medicine | 74186 Tallassee Hwy, Wetumpka, AL 36092-5643 | 2007-01-10 |
| 1376831610 | Southeastern Balance Centers LLC | Podiatrist | 74186 Tallassee Hwy, Suite A, Wetumpka, AL 36092-5643 | 2011-07-20 |
| 1235327503 | Wetumpka Hospitalists, P.C. | Hospitalist | 74186 Tallassee Hwy, Wetumpka, AL 36092-5643 | 2007-10-11 |
| 1578759668 | Tommy W Garnett Dpm | Podiatrist | 74186 Tallassee Hwy, Suite A, Wetumpka, AL 36092-5644 | 2007-09-21 |
| 1548301914 | Grace Pediatrics, LLC | Pediatrics | 74186 Tallassee Hwy, Suite B, Wetumpka, AL 36092-5643 | 2007-02-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578195525 | River Region Family Medicine, LLC | Family Medicine | 277 Huntress Street, Suite 100, Wetumpka, AL 36092 | 2020-02-07 |
| 1710548003 | 2la, LLC | Hearing Instrument Specialist | 4354 Us Highway 231, Suite A, Wetumpka, AL 36092 | 2019-06-26 |
| 1124549308 | Medi - Rides Transport LLC | Non-emergency Medical Transport (VAN) | 173 Hill Street, Suite 103, Wetumpka, AL 36092 | 2017-06-28 |
| 1538699129 | Joni Smart | Pharmacist | 4538 Us Hwy 231, Wetumpka, AL 36092 | 2017-06-15 |
| 1134396898 | Blue Ridge Chiropractic, LLC | Chiropractor | 2412 Us Hwy 231, Wetumpka, AL 36092 | 2008-05-13 |
| 1932243565 | Patricia Dianne White Mcclanahan | Psychologist | 8476 U S Hwy 231 Admh Division of Intellectual Disabili, Comprehensive Support Svcs Riv & V, Wetumpka, AL 36092 | 2007-02-16 |
| 1952472607 | Wetumpka Family Practice Pa | Family Medicine | 73970 Tallassee Hwy, Wetumpka, AL 36092 | 2006-11-13 |
| 1063429744 | Jim G Anderson | Chiropractor | 76299 Tallassee Hwy, Wetumpka, AL 36092 | 2006-08-02 |
| 1710908009 | Winn Dixie Stores Inc | Durable Medical Equipment & Medical Supplies | 5326 Hwy 231 South, Wetumpka, AL 36092 | 2006-07-21 |
| 1629011770 | Spencer J Coleman Sr. | Family Medicine | 73970 Tallassee Highway, Wetumpka, AL 36092 | 2006-06-14 |
| Find all providers in zip 36092 | ||||
| Taxonomy Code | 305R00000X |
| Grouping | Managed Care Organizations |
| Classification | Preferred Provider Organization |
| A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level. |
| Notes: Source: "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/ October 1995, p. 62 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366565152 | Ivycreek of Elmore LLC | Preferred Provider Organization | 41 Cambridge Ct, Wetumpka, AL 36093-1261 | 2007-04-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639523798 | Elite Physical Therapy and Wellness Center, Inc | Preferred Provider Organization | 1404 S Brundidge St, Troy, AL 36081-3129 | 2016-04-14 |
| 1114321643 | Marble City Pediatric Dentistry | Preferred Provider Organization | 1039 W Fort Williams St, Sylacauga, AL 35150-2301 | 2014-10-13 |
| 1093122533 | Noahs Ark Child & Family Treatment Center Inc | Preferred Provider Organization | 1728 5th Ave N, Birmingham, AL 35203-2023 | 2014-07-16 |
| 1932510005 | Robert J. Howard D.m.d., P.C. | Preferred Provider Organization | 705 S George Wallace Dr, Troy, AL 36081-3824 | 2014-05-12 |
| 1407266729 | Precise Family Dental, LLC | Preferred Provider Organization | 23730 John T Reid Pkwy, Suite C, Scottsboro, AL 35768-2839 | 2014-05-08 |
| 1609209253 | Healthsource of Huntsville, LLC | Preferred Provider Organization | 975 Airport Rd Sw, Suite H, Huntsville, AL 35802-1392 | 2013-08-19 |
| 1003150160 | Imaging Network Group, Inc. | Preferred Provider Organization | 26831 Canal Rd Ste 7, Orange Beach, AL 36561-4125 | 2012-11-15 |
| 1083966386 | Kenneth W Chancey Dmd LLC | Preferred Provider Organization | 534 Boll Weevil Cir, Enterprise, AL 36330-4012 | 2012-10-10 |
| 1679839328 | Kenneth E. Pitts, Md, PC | Preferred Provider Organization | 185 Whitesport Dr Sw Ste 4, Huntsville, AL 35801-6487 | 2012-04-06 |
| 1952667123 | Jones Family Services | Preferred Provider Organization | 47 Queen Dr, Columbiana, AL 35051-4082 | 2012-04-02 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.