Novant Health Medical Group, LLC
Organization Active NPI Pediatrics Physician · Huntersville, NC
NPI 1013969674 · NPPES record last updated Jun 20, 2024
Key facts
- NPI
- 1013969674
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- Legal business name
- NOVANT HEALTH MEDICAL GROUP, LLC
- Practice address
- 9615 Kincey Avenue
Suite 100
Huntersville, NC 28078-9140 - Phone
- (704) 316-5635
- Fax
- (704) 316-5640
- NPI assigned
- May 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Leea Jeanine Walton
- Title
- RCS Manager
- Phone
- (704) 316-6081
Practitioners 11
-
Amy Lowery Alexanian, M.D.
-
Anjan Chakrabarty, D.O.
-
Taisha C'Mone Roberts, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D1039753 | Novant Health Gilead Road Pediatrics | Certificate of waiver | Apr 20, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040204001028 | NC | Part B Supplier - Clinic/Group Practice | 1153234893 |
Receives reassigned benefits from 648 practitioners This NPI is an additional NPI on the enrollment Practice locations: Denver, NC; High Point, NC; Huntersville, NC; Indian Trail, NC; Matthews, NC; Monroe, NC; Mooresville, NC; Salisbury, NC… |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | NC | ||
| Pediatrics Physician |
208000000X | NC | Yes |
Addresses
Primary practice location
9615 Kincey Avenue
Suite 100
Huntersville, NC 28078-9140
Mailing address
PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 384-7840
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 017F5 | Other | NC | BCBS-NC |
| 5902021 | Medicaid | NC | |
| CC5118 | Other | NC | RAILROAD MEDICARE |
Other names
- Novant Health Gilead Road Pediatrics & Internal Medicine
Other providers in Huntersville, NC
- Frank D Nottingham
- Novant Health Employer Solutions, LLC
- Novant Health Enterprises Imaging, LLC
- Novant Health Medical Group LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
All providers in Huntersville, NC · Pediatrics Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.