NPIMap

Organization Active NPI

Novant Health Enterprises Imaging, LLC

Doing business as Novant Health Imaging Mallard Creek

  • Diagnostic Radiology Physician
  • Charlotte, NC
National Provider Identifier
1043005689
Registry record updated Nov 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
NOVANT HEALTH ENTERPRISES IMAGING, LLC
Doing business as
Novant Health Imaging Mallard Creek
Practice address
9848 N Tryon St
Charlotte, NC 28262-5512
Phone
(704) 323-3199
Fax
(704) 323-2102
NPI assigned
Apr 14, 2025
Last updated
Nov 6, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2025

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

Authorized official

Name
Mr. Wade Collins
Title
VP of Novant Health Ventures
Phone
(423) 677-0679

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

9848 N Tryon St
Charlotte, NC 28262-5512

Mailing address

9848 N Tryon St
Charlotte, NC 28262-5512
Phone (704) 323-3199

Other names 1

  • Novant Health Imaging Mallard Creek Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Novant Health Enterprises Imaging LLC18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

Practitioners & affiliated clinicians

Practitioners 68

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 68

NPI Registry JSON

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

{
    "created_epoch": "1744588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762387200000",
    "number": "1043005689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9848 N TRYON ST",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282625512",
            "telephone_number": "704-323-3199",
            "fax_number": "704-323-2102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9848 N TRYON ST",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282625512",
            "telephone_number": "704-323-3199",
            "fax_number": "704-323-2102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT HEALTH ENTERPRISES IMAGING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-14",
        "last_updated": "2025-11-06",
        "certification_date": "2025-11-06",
        "status": "A",
        "authorized_official_last_name": "COLLINS",
        "authorized_official_first_name": "WADE",
        "authorized_official_title_or_position": "VP OF NOVANT HEALTH VENTURES",
        "authorized_official_telephone_number": "423-677-0679",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Imaging Mallard Creek",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.