| Iredell Physician Network Llc | |
|
766 Hartness Rd Statesville NC 28677-3479 | |
| (704) 883-3378 | |
| (704) 883-3228 |
| Full Name | Iredell Physician Network Llc |
|---|---|
| Speciality | General Practice |
| Location | 766 Hartness Rd, Statesville, North Carolina |
| Authorized Official Name and Position | Carla D Johnson (DIRECTOR OF OPERATIONS) |
| Authorized Official Contact | 9804343803 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Iredell Physician Network Llc Po Box 896199 Charlotte NC 28289-6199 Ph: (833) 936-1364 | Iredell Physician Network Llc 766 Hartness Rd Statesville NC 28677-3479 Ph: (704) 883-3378 |
| NPI Number | 1811381593 |
|---|---|
| Provider Enumeration Date | 03/20/2015 |
| Last Update Date | 10/07/2021 |
| Medicare PECOS PAC ID | 0749345007 |
|---|---|
| Medicare Enrollment ID | O20090219000651 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811381593 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Anthony D Elkins |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669445847 PECOS PAC ID: 7416840152 Enrollment ID: I20040205000753 |
| Provider Name | Penney Elaine Parker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831168855 PECOS PAC ID: 3173412095 Enrollment ID: I20040310001390 |
| Provider Name | John Joseph Allan |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1235121997 PECOS PAC ID: 5193787273 Enrollment ID: I20041101000584 |
| Provider Name | William B Newton |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1215912258 PECOS PAC ID: 0042275778 Enrollment ID: I20041122001153 |
| Provider Name | Robert J Ward |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326157991 PECOS PAC ID: 0648219089 Enrollment ID: I20050426000880 |
| Provider Name | Andora Nicholson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902820632 PECOS PAC ID: 0143237123 Enrollment ID: I20060316000072 |
| Provider Name | Jason J Batley |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1962463372 PECOS PAC ID: 8820093677 Enrollment ID: I20060928000578 |
| Provider Name | Dominick J Carbone |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1790767382 PECOS PAC ID: 9335146778 Enrollment ID: I20061027000389 |
| Provider Name | Malinda S Sherrill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902954050 PECOS PAC ID: 0244328870 Enrollment ID: I20071115000483 |
| Provider Name | James H Bradford |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1114032398 PECOS PAC ID: 9638266232 Enrollment ID: I20080219000073 |
| Provider Name | Naim E Bouhussein |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1932214137 PECOS PAC ID: 1456448059 Enrollment ID: I20080219000091 |
| Provider Name | John C Nicholson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497723795 PECOS PAC ID: 3678644218 Enrollment ID: I20080625000372 |
| Provider Name | Latasha M Ellis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487832671 PECOS PAC ID: 7517012271 Enrollment ID: I20090901000378 |
| Provider Name | Kenesha H Kirkland |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275662256 PECOS PAC ID: 0648317214 Enrollment ID: I20091030000331 |
| Provider Name | Ruby A Grimm |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154312841 PECOS PAC ID: 2860533718 Enrollment ID: I20100114000199 |
| Provider Name | Elmer H Stout |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851370282 PECOS PAC ID: 9335108406 Enrollment ID: I20100121000694 |
| Provider Name | William John Edmiston |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1053420190 PECOS PAC ID: 1759416050 Enrollment ID: I20100311000678 |
| Provider Name | Joseph S Wolyniak |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1053390856 PECOS PAC ID: 1759417546 Enrollment ID: I20100331000654 |
| Provider Name | Charles A Deberardinis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659311207 PECOS PAC ID: 1153355839 Enrollment ID: I20100429000775 |
| Provider Name | Jessica Daniels Wood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558695213 PECOS PAC ID: 2264561588 Enrollment ID: I20100525000992 |
| Provider Name | Joel Ray Inman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922038686 PECOS PAC ID: 2365336344 Enrollment ID: I20100714000471 |
| Provider Name | Lewis J Tondo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114922622 PECOS PAC ID: 5698807774 Enrollment ID: I20100803000552 |
| Provider Name | Christian Finn Sorensen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730138066 PECOS PAC ID: 5092782219 Enrollment ID: I20110412000629 |
| Provider Name | Joseph C Mazzola |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457368185 PECOS PAC ID: 4688663792 Enrollment ID: I20110627000336 |
| Provider Name | Peter D Miller |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1508868647 PECOS PAC ID: 0345421186 Enrollment ID: I20120130000829 |
| Provider Name | Maryna R Yacinthe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558703090 PECOS PAC ID: 8325282593 Enrollment ID: I20130910000719 |
| Provider Name | Deepak Joshi |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1154506582 PECOS PAC ID: 4789733940 Enrollment ID: I20140926001324 |
| Provider Name | Dana P Short |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962817528 PECOS PAC ID: 8426270679 Enrollment ID: I20141104001186 |
| Provider Name | Ella Davila Hernandez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952707473 PECOS PAC ID: 7911221262 Enrollment ID: I20150115001549 |
| Provider Name | Jonathon B Bringolf |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1215294483 PECOS PAC ID: 8729391784 Enrollment ID: I20150720002046 |
| Provider Name | Nunta Jitoun Campbell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609259183 PECOS PAC ID: 4587972047 Enrollment ID: I20151001003051 |
| Provider Name | Stephanie Ann Welch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053669184 PECOS PAC ID: 6507096484 Enrollment ID: I20151221000403 |
| Provider Name | Angela Kay Robertson-turner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619421088 PECOS PAC ID: 9739477746 Enrollment ID: I20161006001675 |
| Provider Name | Stephanie Paige Little |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902019409 PECOS PAC ID: 3476822917 Enrollment ID: I20170627001247 |
| Provider Name | Vijay S Nagpal |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1720473572 PECOS PAC ID: 7416266903 Enrollment ID: I20170706000963 |
| Provider Name | Suja Raju |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003254806 PECOS PAC ID: 4789957333 Enrollment ID: I20170905000376 |
| Provider Name | Tyler Stanley Woodrum |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1124415955 PECOS PAC ID: 9032429253 Enrollment ID: I20170908002059 |
| Provider Name | Jonathan Paul Goodnight |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780003699 PECOS PAC ID: 9739193798 Enrollment ID: I20170911002730 |
| Provider Name | Eva Imperial |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023018082 PECOS PAC ID: 4789585738 Enrollment ID: I20171031000086 |
| Provider Name | Jennifer Cashion Waugh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154849107 PECOS PAC ID: 7315203114 Enrollment ID: I20171110001991 |
| Provider Name | Andrea Colvin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053824078 PECOS PAC ID: 6305105313 Enrollment ID: I20180122000426 |
| Provider Name | Hannah Elizabeth Wyatt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619480738 PECOS PAC ID: 6901168913 Enrollment ID: I20180402000826 |
| Provider Name | James G Sowards |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1821050832 PECOS PAC ID: 4587656434 Enrollment ID: I20180404000799 |
| Provider Name | Shannon N Mumma |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1063891166 PECOS PAC ID: 5193034858 Enrollment ID: I20180817000053 |
| Provider Name | Kristie D. Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407860182 PECOS PAC ID: 9133125032 Enrollment ID: I20190408001919 |
| Provider Name | Nicholas Paul Petit |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1174986517 PECOS PAC ID: 3274826581 Enrollment ID: I20190722003227 |
| Provider Name | Kaleah Hendren |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518525484 PECOS PAC ID: 7315279395 Enrollment ID: I20191023003247 |
| Provider Name | Terri Chang Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457996274 PECOS PAC ID: 2961837133 Enrollment ID: I20200115003320 |
| Provider Name | Bradley A Martin |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1952620536 PECOS PAC ID: 9830492537 Enrollment ID: I20200720003533 |
| Provider Name | Dino Music |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881934255 PECOS PAC ID: 1153561279 Enrollment ID: I20200901003226 |
| Provider Name | Katie T Kissel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710518220 PECOS PAC ID: 2860803038 Enrollment ID: I20201118002336 |
| Provider Name | Allison Cecilia Clay |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689230237 PECOS PAC ID: 7113334046 Enrollment ID: I20210322000382 |
| Provider Name | Rachel Disanto |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518081520 PECOS PAC ID: 7517051261 Enrollment ID: I20210406001695 |
| Provider Name | Andrea Lynn Francis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275101388 PECOS PAC ID: 8123429065 Enrollment ID: I20210629002000 |
| Provider Name | Judith Prairie |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407352255 PECOS PAC ID: 2163850942 Enrollment ID: I20210720002849 |
| Provider Name | Samuel J Stelmach |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124473152 PECOS PAC ID: 1153612460 Enrollment ID: I20210825003746 |
| Provider Name | Caitlin Basnight |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043702954 PECOS PAC ID: 9638412356 Enrollment ID: I20210914003018 |
| Provider Name | Nichole Bentley Lemley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972270320 PECOS PAC ID: 3577961200 Enrollment ID: I20211012000337 |
| Provider Name | Nadia Nasser |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1013366699 PECOS PAC ID: 9830480631 Enrollment ID: I20211221002465 |
| Provider Name | Ashi Chabeda |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467814418 PECOS PAC ID: 3173915493 Enrollment ID: I20220119001162 |
| Provider Name | Tina Louise Kinney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548529050 PECOS PAC ID: 5991961500 Enrollment ID: I20230523003221 |
| Provider Name | Taylor J Hollingsworth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134812506 PECOS PAC ID: 8325400070 Enrollment ID: I20230814000900 |
| Provider Name | Maria Tletee |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760026918 PECOS PAC ID: 1557724630 Enrollment ID: I20230823002340 |
| Provider Name | Michael T Tjahjadi |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1699188912 PECOS PAC ID: 0941596910 Enrollment ID: I20231207003540 |
Piedmont Healthcare, Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 533 Brookdale Dr, Statesville, NC 28677 Phone: 704-838-8249 Fax: 704-495-3057 | |
Nuvu Health Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 611 Sullivan Rd, Statesville, NC 28677 Phone: 980-434-5426 | |
Sound Physicians Of North Carolina Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 218 Old Mocksville Rd, Statesville, NC 28625 Phone: 704-873-0281 Fax: 704-838-7287 | |
Piedmont Healthcare, Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 705 Gaither Rd, Statesville, NC 28625 Phone: 704-871-1155 Fax: 704-872-2484 | |
Statesville Family Practice Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 310 Davie Ave, Statesville, NC 28677 Phone: 704-873-3269 Fax: 704-871-8159 | |
Novant Health Primary Care Fern Creek Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1410 Fern Creek Dr, Statesville, NC 28625 Phone: 704-978-2250 Fax: 704-978-2258 | |
Cuong Tan Doan Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 557 Brookdale Dr, Statesville, NC 28677 Phone: 800-409-2919 |