Active NPI
Novant Medical Group Inc
- Orthopaedic Surgery Physician
- Matthews, NC
National Provider Identifier
1114366994
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- Legal business name
- NOVANT MEDICAL GROUP INC
- Practice address
- 1450 Matthews Township Parkway
Suite 355
Matthews, NC 28105-4300 - Phone
- (704) 544-6920
- NPI assigned
- Jun 14, 2013
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Geoffrey Keith Gardner
- Title
- VP Finance
- Phone
- (704) 544-6920
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurological Surgery Physician | 207T00000X | |||
| Orthopaedic Surgery Physician | 207X00000X | Primary | ||
| Physical Medicine & Rehabilitation Physician | 208100000X | |||
| Pain Medicine Physician | 208VP0000X |
Addresses
Primary practice location
1450 Matthews Township Parkway
Suite 355
Matthews, NC 28105-4300
Mailing address
PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 384-7840
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114366994 | Medicaid | NC |
Other names 1
- Novant Health Total Spine Specialists
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 DirectoryPractitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Pain Medicine (Physical Medicine & Rehabilitation) Physician
- Charlotte, NC
- NPI 1831311679
Physical Medicine & Rehabilitation
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1371168000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1395878400000",
"number": "1114366994",
"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"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1450 MATTHEWS TOWNSHIP PARKWAY",
"address_2": "SUITE 355",
"city": "MATTHEWS",
"state": "NC",
"postal_code": "281054300",
"telephone_number": "704-544-6920"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NOVANT MEDICAL GROUP INC",
"organizational_subpart": "NO",
"enumeration_date": "2013-06-14",
"last_updated": "2014-03-27",
"status": "A",
"authorized_official_last_name": "GARDNER",
"authorized_official_first_name": "GEOFFREY",
"authorized_official_middle_name": "KEITH",
"authorized_official_title_or_position": "VP FINANCE",
"authorized_official_telephone_number": "704-544-6920",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "207T00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Neurological Surgery",
"state": null,
"license": null,
"primary": false
},
{
"code": "207X00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Orthopaedic Surgery",
"state": null,
"license": null,
"primary": true
},
{
"code": "208100000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physical Medicine & Rehabilitation",
"state": null,
"license": null,
"primary": false
},
{
"code": "208VP0000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pain Medicine, Pain Medicine",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1114366994",
"state": "NC"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Novant Health Total Spine Specialists",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Matthews, NC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Prep II LLC
- Novant Health Rehabilitation Center Matthews
- Novant Medical Group Inc
- Novant Medical Group, Inc
- Novant Medical Group, Inc.
- Novant Medical Group, Inc.
- Novant Medical Group, Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2014; 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.