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STATESVILLE FAMILY PRACTICE
NPI 1053360180
Family Medicine in Statesville, NC

Active since May 08, 2006CLIA 34D0247344 · Waiver
310 DAVIE AVE, STATESVILLE, NC 28677(704) 873-3269(704) 871-8159 Get Directions Write a Review

NPPES record last updated: October 1, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Oct 1, 2024, Sep 24, 2024, Feb 4, 2022 and 1 more (4 updates tracked since 2021).

About Statesville Family Practice NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

STATESVILLE FAMILY PRACTICE (NPI 1053360180) is a healthcare organization registered as a family medicine in Statesville, North Carolina and active in the NPI registry since May 2006. The organization holds a CLIA Waiver certificate valid through August 31, 2026 and lists Carla Johnson, Director Of Operations, as its authorized official.

NPPES Registry Identity

NPI1053360180
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameIREDELL PHYSICIAN NETWORK LLC
Location Address310 DAVIE AVEStatesville, NC 28677-5319
Mailing AddressPo Box 896199Charlotte, NC 28289-6199 · (833) 936-1364 · Fax (605) 942-7505
Phone(704) 873-3269
Fax(704) 871-8159
Organization SubpartYes
Authorized OfficialCarla JohnsonDirector Of Operations · (704) 873-5661
Enumeration DateMay 8, 2006
Last NPPES UpdateOctober 1, 20244 updates tracked since enumeration
NPPES CertifiedOctober 1, 2024
✔ NPI 1053360180 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
310 DAVIE AVE, Statesville, NC 28677
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Other Names 1

Doing Business AsStatesville Family Practice

Other Identifiers 1

Medicaid8902748NC

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter of North Carolina, Ambetter of Tennessee and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 34D0247344

Statesville Family Practice · Statesville, NC
Active · expires Aug 31, 2026
CLIA Number34D0247344
Laboratory TypePhysician Office
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorRachel B. Disanto
Laboratory Phone(704) 873-3269
Laboratory LocationStatesville Family Practice310 Davie Ave, Statesville, NC 28677
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. KACIE MILLER TEETER PA-C
Physician Assistant (Medical)
310 DAVIE AVE, STATESVILLE FAMILY PRACTICE
STATESVILLE, NC 28677
Iredell County (704) 873-3269
JOSEPH C. MAZZOLA D.O.
Family Medicine
310 DAVIE AVE
STATESVILLE, NC 28677
Iredell County (704) 873-3269
DR. RACHEL BETH DISANTO M.D.
Family Medicine
310 DAVIE AVE
STATESVILLE, NC 28677
Iredell County (704) 873-3269
DAVID WAYNE CASH MD
Family Medicine
310 DAVIE AVE
STATESVILLE, NC 28677
Iredell County (704) 873-3269

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Iredell Physician Network LLC's NPI number?

The NPI number for Iredell Physician Network LLC is 1053360180. It was assigned to this organization in the NPPES registry on May 8, 2006. The provider is doing business as Statesville Family Practice.

Where is Iredell Physician Network LLC located?

Iredell Physician Network LLC is located at 310 Davie Ave, Statesville, NC 28677. The listed phone number is (704) 873-3269.

What is Iredell Physician Network LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Iredell Physician Network LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 34D0247344) is associated with this NPI, valid through August 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Iredell Physician Network LLC accept?

Health plans from Ambetter from Absolute Total Care, Ambetter of North Carolina, Ambetter of Tennessee and AmeriHealth Caritas Next list Iredell Physician Network LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Iredell Physician Network LLC was last updated on October 1, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.