NPIMap

Organization Active NPI

Novant Medical Group, Inc

Doing business as Novant Health Psychiatric Medicine

  • Neurology Physician
  • Winston Salem, NC
National Provider Identifier
1043503287
Registry record updated Jun 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
NOVANT MEDICAL GROUP, INC
Doing business as
Novant Health Psychiatric Medicine
Practice address
175 Kimel Park Dr
Suite 100
Winston Salem, NC 27103-6951
Phone
(336) 277-1800
Fax
(336) 277-9538
NPI assigned
May 20, 2011
Last updated
Jun 21, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2013

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

Authorized official

Name
Geoffrey K Gardner
Title
VP of Finance
Phone
(704) 384-9094

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X Primary

Addresses

Primary practice location

175 Kimel Park Dr
Suite 100
Winston Salem, NC 27103-6951

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 384-7840

Other identifiers 1

IdentifierTypeStateIssuer
5917753MedicaidNC

Other names 1

  • Novant Health Psychiatric Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031121000692 NC Part B Supplier - Clinic/Group Practice 1153234893 Receives reassigned benefits from 3,607 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
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.

View all 24

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1305849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371772800000",
    "number": "1043503287",
    "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",
            "telephone_number": "704-384-7840",
            "fax_number": "704-384-7830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 KIMEL PARK DR",
            "address_2": "SUITE 100",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036951",
            "telephone_number": "336-277-1800",
            "fax_number": "336-277-9538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-20",
        "last_updated": "2013-06-21",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "GEOFFREY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "704-384-9094"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5917753",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Psychiatric Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2013; 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.