Novant Health Medical Group, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

NOVANT HEALTH MEDICAL GROUP, LLC

Practice address

2025 Frontis Plaza Blvd Ste 120
Winston Salem, NC 27103-5663

Phone

(336) 774-3740

NPI assigned

Jan 14, 2025

Organization subpart

No

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

(704) 316-6081

Specialties & licenses 1

Addresses

Other names 1

• Novant Health Premier Dermatology Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Presbyterian Inpt Care503 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

• Novant Health Medical Group LLC

  • Occupational Medicine Physician
  • Winston Salem, NC
  • NPI 1013483866
  NPD tax ID
• Novant Health Medical Group LLC

  • Psychiatry Physician
  • Charlotte, NC
  • NPI 1013723162
  NPD tax ID
• Novant Health Medical Group, LLC

  • Cardiovascular Disease Physician
  • Winston Salem, NC
  • NPI 1023798931
  NPD tax ID
• Novant Health Medical Group, LLC

  • Hospitalist Physician
  • Kernersville, NC
  • NPI 1033415377
  NPD tax ID
• Novant Health Medical Group, LLC

  • Pulmonary Disease Physician
  • Monroe, NC
  • NPI 1033664933
  NPD tax ID
• Novant Health Medical Group, LLC

  • Internal Medicine Physician
  • Charlotte, NC
  • NPI 1033698527
  NPD tax ID
• Novant Health Medical Group, LLC

  • Family Medicine Physician
  • Bolivia, NC
  • NPI 1043564891
  NPD tax ID
• Novant Health Medical Group, LLC

  • Neurology Physician
  • Winston Salem, NC
  • NPI 1043713910
  NPD tax ID
• Novant Health Medical Group, LLC

  • Family Medicine Physician
  • Winston-Salem, NC
  • NPI 1043992100
  NPD tax ID
• Novant Health Medical Group, LLC

  • Pediatrics Physician
  • Charlotte, NC
  • NPI 1053838789
  NPD tax ID
• Novant Health Medical Group, LLC

  • Obstetrics & Gynecology Physician
  • Mooresville, NC
  • NPI 1053878868
  NPD tax ID
• Novant Health Medical Group, LLC

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Matthews, NC
  • NPI 1063210110
  NPD tax ID

Locations

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

{
    "created_epoch": "1736812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739145600000",
    "number": "1043021686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2025 FRONTIS PLAZA BLVD STE 120",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271035663",
            "telephone_number": "336-774-3740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT HEALTH MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-14",
        "last_updated": "2025-02-10",
        "certification_date": "2025-02-10",
        "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": "704-316-6081"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Premier Dermatology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Novant Health Premier Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 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
• Novant Health Medical Group, LLC
• Novant Health Medical Group, LLC

• All providers in Winston Salem, NC
• Dermatology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.