NPIMap

Organization Active NPI

Novant Health Medical Group, LLC

Doing business as Novant Health Triad Obstetrics & Gynecology

  • Obstetrics & Gynecology Physician
  • Winston Salem, NC
National Provider Identifier
1083986111
Registry record updated Jun 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
NOVANT HEALTH MEDICAL GROUP, LLC
Doing business as
Novant Health Triad Obstetrics & Gynecology
Practice address
2909 Maplewood Avenue
Winston Salem, NC 27103
Phone
(336) 277-0340
Fax
(336) 277-0359
NPI assigned
Feb 6, 2012
Last updated
Jun 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2024

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

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X NU Primary

Addresses

Primary practice location

2909 Maplewood Avenue
Winston Salem, NC 27103

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (336) 277-0340

Other identifiers 2

IdentifierTypeStateIssuer
1083986111MedicaidNC
5919510OtherNCFORMER NC MEDICAID NUMBER

Other names 1

  • Novant Health Triad Obstetrics & Gynecology 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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2037175Novant Health Triad Obstetrics & Gynecology2909 Maplewood Avenue, Winston-Salem, NC 27103Provider-performed microscopyAug 25, 2026

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

Locations

280 Broad St
Ste D
Kernersville, NC 27284
Phone (336) 718-7470

1900 S Hawthorne Rd
Ste 614
Winston Salem, NC 27103
Phone (336) 277-0340

Practitioners & affiliated clinicians

Practitioners 6

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": "1328486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718928000000",
    "number": "1083986111",
    "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": "336-277-0340",
            "fax_number": "336-277-0359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2909 MAPLEWOOD AVENUE",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "27103",
            "telephone_number": "336-277-0340",
            "fax_number": "336-277-0359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT HEALTH MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-06",
        "last_updated": "2024-06-21",
        "certification_date": "2024-06-21",
        "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": "704-316-6081"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1083986111",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FORMER NC MEDICAID NUMBER",
            "identifier": "5919510",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Triad Obstetrics & Gynecology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Novant Health Triad Obstetrics & Gynecology",
            "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, 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.