NPIMap

Organization Active NPI

Novant Health Prep II LLC

Doing business as Surgical Specialists of Charlotte, a Novant Health network provider

  • Surgery Physician
  • Rock Hill, SC
National Provider Identifier
1033910708
Registry record updated Apr 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
NOVANT HEALTH PREP II LLC
Doing business as
Surgical Specialists of Charlotte, a Novant Health network provider
Practice address
1721 Ebenezer Rd Ste 175
Rock Hill, SC 29732-1188
Phone
(803) 324-5256
Fax
(803) 328-0440
NPI assigned
Mar 20, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Leea Jeanine Walton
Title
RCS Manager
Phone
(336) 515-7085

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

1721 Ebenezer Rd Ste 175
Rock Hill, SC 29732-1188

Mailing address

PO Box 604350
Charlotte, NC 28260-4350

Other names 1

  • Surgical Specialists of Charlotte, a Novant Health network provider Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250408001711 SC Part B Supplier - Clinic/Group Practice 1052835311 Receives reassigned benefits from 21 practitioners
2 other NPIs on this enrollment
Practice locations: Fort Mill, SC; Rock Hill, SC

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Novant Health Prep II LLC9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1742428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745193600000",
    "number": "1033910708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 604350",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282604350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1721 EBENEZER RD STE 175",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297321188",
            "telephone_number": "803-324-5256",
            "fax_number": "803-328-0440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT HEALTH PREP II LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-20",
        "last_updated": "2025-04-21",
        "certification_date": "2025-04-21",
        "status": "A",
        "authorized_official_last_name": "WALTON",
        "authorized_official_first_name": "LEEA",
        "authorized_official_middle_name": "JEANINE",
        "authorized_official_title_or_position": "RCS MANAGER",
        "authorized_official_telephone_number": "336-515-7085"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Surgical Specialists of Charlotte, a Novant Health network provider",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Surgical Specialists of Charlotte, a Novant Health network provider",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rock Hill, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.