NPIMap

Organization Active NPI

Novant Health Medical Group Coastal Region, LLC

  • Pediatrics Physician
  • Wilmington, NC
National Provider Identifier
1144800137
Registry record updated Oct 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
NOVANT HEALTH MEDICAL GROUP COASTAL REGION, LLC
Practice address
2131 S 17TH St
Wilmington, NC 28401-7407
Phone
(910) 662-9300
NPI assigned
Apr 13, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2024

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

Authorized official

Name
Leea Jeanine Walton
Title
Enrollment Manager
Phone
(336) 515-7085

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary
Pediatric Cardiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0202X
Pediatric Urology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2088P0231X

Addresses

Primary practice location

2131 S 17TH St
Wilmington, NC 28401-7407

Mailing address

PO Box 936857
Atlanta, GA 31193-6857

Other practice location 1

109 Scotts Hill Dr
Ste 204
Wilmington, NC 28411
Phone (910) 667-4620

Other practice location 2

20 Medical Campus Dr NW Ste 205
Supply, NC 28462-4094
Phone (910) 662-8888

Other practice location 3

2000 Brabham Ave
Jacksonville, NC 28546-0201
Phone (910) 662-8888

Other practice location 4

510 Carolina Bay Dr Ste 200
Wilmington, NC 28403-2046
Phone (910) 662-8906

Other names 1

  • Novant Health UNC Children's Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210408000285 NC Part B Supplier - Clinic/Group Practice 2860809936 Receives reassigned benefits from 798 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Wilmington, NC; Wilmington, NE; Boivia, NC; Bolivia, NC; Burgaw, NC; Carolina Shores, NC; Jacksonville, NC; Leland, NC…

National Provider Directory

National Provider Directory
Tax ID family
Novant Health Medical Group Coastal Region LLC56 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 20

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

View all 20

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1618272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729555200000",
    "number": "1144800137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 936857",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311936857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2131 S 17TH ST",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017407",
            "telephone_number": "910-662-9300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "109 Scotts Hill Dr",
            "address_2": "Ste 204",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "28411",
            "country_code": "US",
            "telephone_number": "910-667-4620",
            "fax_number": "910-667-4639",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "20 Medical Campus Dr NW Ste 205",
            "address_purpose": "LOCATION",
            "city": "Supply",
            "state": "NC",
            "postal_code": "284624094",
            "country_code": "US",
            "telephone_number": "910-662-8888",
            "fax_number": "910-777-5031",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2000 Brabham Ave",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "NC",
            "postal_code": "285460201",
            "country_code": "US",
            "telephone_number": "910-662-8888",
            "fax_number": "910-662-8906",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "510 Carolina Bay Dr Ste 200",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284032046",
            "country_code": "US",
            "telephone_number": "910-662-8906",
            "fax_number": "910-662-8888",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NOVANT HEALTH MEDICAL GROUP COASTAL REGION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-13",
        "last_updated": "2024-10-22",
        "certification_date": "2024-10-19",
        "status": "A",
        "authorized_official_last_name": "WALTON",
        "authorized_official_first_name": "LEEA",
        "authorized_official_middle_name": "JEANINE",
        "authorized_official_title_or_position": "ENROLLMENT MANAGER",
        "authorized_official_telephone_number": "336-515-7085"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2088P0231X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology, Pediatric Urology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health UNC Children's",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2024; 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.