Novant Health Medical Group, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

NOVANT HEALTH MEDICAL GROUP, LLC

Doing business as

Novant Health Lakeside Primary Care

Practice address

13460 Plaza Road Ext Ste 100
Charlotte, NC 28215-8923

Phone

(704) 316-4990

Fax

(704) 316-4998

NPI assigned

May 15, 2012

Last updated

Jul 9, 2024By the provider in NPPES

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 identifiers 1

Other names 1

• Novant Health Lakeside Primary Care 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

Locations

Practitioners 7

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.

• Rachel Renee Banks, MD

  • Family Medicine Physician
  • Charlotte, NC
  • NPI 1780713230
  NPD
• Sheryl Maria Savita De Sa

  • Family Medicine Physician
  • Concord, NC
  • NPI 1083121776

  Multi-Specialty

  NPD
• Janna Kristen Featherstone

  • Family Medicine Physician
  • Locust, NC
  • NPI 1194349340
  NPD
• Joseph Anthony Garcia, M.D.

  • Family Medicine Physician
  • Huntersville, NC
  • NPI 1215916119
  NPD
• John Lyle McGuinness

  • Internal Medicine Physician
  • Mooresville, NC
  • NPI 1639263759
  NPD
• Bridget Chinelo Nduka, DO

  • Family Medicine Physician
  • Concord, NC
  • NPI 1013473438
  NPD
• Amanda Joy Whitley, MD

  • Family Medicine Physician
  • Charlotte, NC
  • NPI 1104955632
  NPD

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

{
    "created_epoch": "1337040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720483200000",
    "number": "1063771749",
    "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": "704-384-7603",
            "fax_number": "704-417-4479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13460 PLAZA ROAD EXT STE 100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282158923",
            "telephone_number": "704-316-4990",
            "fax_number": "704-316-4998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT HEALTH MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-15",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "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": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5921588",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Lakeside Primary Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Novant Health Lakeside Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Novant Health Medical Group, LLC (Novant Health Surgical Wellness)
• Novant Health Medical Group, LLC (Novant Health Blakeney Family Physicians)
• Novant Health Medical Group, LLC (Novant Health Orthopedics & Sports Medicine)
• Novant Health Medical Group, LLC (Novant Health Pediatrics Highland Creek & After Hours Care)
• Novant Health Medical Group, LLC (NHMG Surgery Clinics)
• Novant Health Medical Group, LLC (Novant Health Cancer Institute)
• Novant Health Medical Group, LLC (Novant Health Queen City OB/GYN)
• Novant Health Medical Group, LLC (NHMG Pulmonology Clinics)
• Novant Health Medical Group, LLC (Novant Health Pediatric Cardiology)
• Novant Health Medical Group, LLC (Novant Health Charlotte Colon & Rectal Surgery)

• Family Medicine Physician in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2024; 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.