| Ivy Creek Family Care Of Lake Martin | |
|
5958 Highway 49 S Unit K Dadeville AL 36853-6771 | |
| (256) 825-7821 | |
| Not Available |
| Full Name | Ivy Creek Family Care Of Lake Martin |
|---|---|
| Speciality | Clinic/Center |
| Location | 5958 Highway 49 S Unit K, Dadeville, Alabama |
| Authorized Official Name and Position | Jade Lane (CREDENTIALING MANAGER) |
| Authorized Official Contact | 3345674311 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ivy Creek Family Care Of Lake Martin Po Box 130 Wetumpka AL 36092-0003 Ph: (334) 514-3821 | Ivy Creek Family Care Of Lake Martin 5958 Highway 49 S Unit K Dadeville AL 36853-6771 Ph: (256) 825-7821 |
| NPI Number | 1609572890 |
|---|---|
| Provider Enumeration Date | 01/31/2023 |
| Last Update Date | 03/20/2025 |
| Medicare PECOS PAC ID | 6103281977 |
|---|---|
| Medicare Enrollment ID | O20230501000230 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609572890 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QU0200X | Clinic/center - Urgent Care | (* (Not Available)) | Primary |
| Provider Name | John R Durant |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790717858 PECOS PAC ID: 7810800091 Enrollment ID: I20031112000675 |
| Provider Name | Todd C Brightbill |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1619972874 PECOS PAC ID: 9537073168 Enrollment ID: I20050314000914 |
| Provider Name | Matthew Larrison |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1881659407 PECOS PAC ID: 8729099494 Enrollment ID: I20060509000504 |
| Provider Name | Barbara F Wilder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598797656 PECOS PAC ID: 5597836643 Enrollment ID: I20080617000259 |
| Provider Name | Laura R Daniel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952634248 PECOS PAC ID: 3375686520 Enrollment ID: I20100210000256 |
| Provider Name | Robert Alan Schuster |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871525931 PECOS PAC ID: 1951378934 Enrollment ID: I20100818000768 |
| Provider Name | Sharon M Hamlin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790060341 PECOS PAC ID: 6305004847 Enrollment ID: I20120229000890 |
| Provider Name | Julia Morris |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1699956623 PECOS PAC ID: 6709042971 Enrollment ID: I20120717000342 |
| Provider Name | Manish Y Patel |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1205070851 PECOS PAC ID: 5991944068 Enrollment ID: I20140503000026 |
| Provider Name | Maximilian Pyko |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1477782969 PECOS PAC ID: 0648585810 Enrollment ID: I20150817002431 |
| Provider Name | Brian Heath Daniel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912359100 PECOS PAC ID: 0840578449 Enrollment ID: I20161102002160 |
| Provider Name | Cathy Pitts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508314865 PECOS PAC ID: 5991072076 Enrollment ID: I20170519001381 |
| Provider Name | Daniel James Israel |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1568721991 PECOS PAC ID: 0143464412 Enrollment ID: I20170831002922 |
| Provider Name | Lori M Mosley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578072757 PECOS PAC ID: 8123387016 Enrollment ID: I20180123001061 |
| Provider Name | Chad Cox |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1518385384 PECOS PAC ID: 5597096776 Enrollment ID: I20200618003156 |
| Provider Name | Emmanuel N Ozimba |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245233832 PECOS PAC ID: 8628010501 Enrollment ID: I20201228000265 |
| Provider Name | Timothy James Littmann |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477050680 PECOS PAC ID: 1456752690 Enrollment ID: I20210625001584 |
| Provider Name | Brent Jordan |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1194107839 PECOS PAC ID: 6709204639 Enrollment ID: I20220802001973 |
| Provider Name | Michael L Bevels |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093595746 PECOS PAC ID: 2860469848 Enrollment ID: I20240319001996 |
| Provider Name | Benjamin J Chappell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073181426 PECOS PAC ID: 3870997570 Enrollment ID: I20240725004204 |
| Provider Name | Jon Mather |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1932465812 PECOS PAC ID: 9436424405 Enrollment ID: I20250122000192 |
| Provider Name | Shankar Iyer |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1568027860 PECOS PAC ID: 3476070129 Enrollment ID: I20250507000567 |
| Provider Name | Dana Bonaminio |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1659606788 PECOS PAC ID: 9032355870 Enrollment ID: I20250512000767 |
| Provider Name | Kevin Cunneely |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1356389597 PECOS PAC ID: 9830100767 Enrollment ID: I20250512001608 |
| Provider Name | David Sarver |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1750624144 PECOS PAC ID: 7416273883 Enrollment ID: I20250513000105 |
| Provider Name | Stephen Cole |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1740609684 PECOS PAC ID: 5890098180 Enrollment ID: I20250513000780 |
| Provider Name | Lee Rogers |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1720286487 PECOS PAC ID: 1456443787 Enrollment ID: I20250513002439 |
| Provider Name | Gabriel Starace |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1992960298 PECOS PAC ID: 1052557907 Enrollment ID: I20250514001881 |
| Provider Name | Neal Langdon |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1376986828 PECOS PAC ID: 3678875283 Enrollment ID: I20250514002276 |
| Provider Name | Steven Shaba |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1396909255 PECOS PAC ID: 4284804022 Enrollment ID: I20250514003184 |
| Provider Name | Reagan Leverett |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1902953870 PECOS PAC ID: 9133290562 Enrollment ID: I20250515002506 |
| Provider Name | Vineet Sharma |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1508804337 PECOS PAC ID: 5597710863 Enrollment ID: I20250516000091 |
| Provider Name | Leomar Bautista |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1477930337 PECOS PAC ID: 0042632226 Enrollment ID: I20250516002322 |
| Provider Name | Jeffrey Michael Huggett |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1447299698 PECOS PAC ID: 5092618256 Enrollment ID: I20250519003067 |
| Provider Name | Stephen Fisher |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1184990574 PECOS PAC ID: 9830466101 Enrollment ID: I20250520004944 |
| Provider Name | Michael C Cian |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1902845118 PECOS PAC ID: 7810899499 Enrollment ID: I20250521003530 |
| Provider Name | Lauren Gates |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1811343015 PECOS PAC ID: 5799078879 Enrollment ID: I20250530000406 |
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