Novant Medical Group, Inc

Primary specialty

Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X

License

25806 Issued in NC

Legal business name

NOVANT MEDICAL GROUP, INC

Practice address

301 Hawthorne LN Ste 200
Charlotte, NC 28204-2467

Phone

(704) 384-7606

NPI assigned

Nov 13, 2017

Organization subpart

No

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) 384-7840

Specialties & licenses 2

Addresses

Other names 1

• Novant Health Thoracic Surgery Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Practitioners 4

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

• Oluseun Olukayode Alli, MD

  • Interventional Cardiology Physician
  • Charlotte, NC
  • NPI 1053524967
  NPD
• Kathleen Wilkin Lagesse, AGNP-C

  • Nurse Practitioner
  • Mooresville, NC
  • NPI 1316496862
  NPD
• Kathryn Alice Lofland, FNP

  • Nurse Practitioner
  • Winston Salem, NC
  • NPI 1235536210
  NPD
• Tom Prakash Theruvath, M.D.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Charlotte, NC
  • NPI 1083875058

  Thoracic Surgery (Cardiothoracic Vascular Surgery)

  NPD

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

{
    "created_epoch": "1510531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510531200000",
    "number": "1174036115",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 HAWTHORNE LN STE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282042467",
            "telephone_number": "704-384-7606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-13",
        "last_updated": "2017-11-13",
        "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": "704-384-7840"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "NC",
            "license": "25806",
            "primary": true
        },
        {
            "code": "261QX0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oncology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Thoracic Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Novant Medical Group Inc.
• Novant Medical Group, Inc
• Novant Medical Group, Inc
• Novant Medical Group, Inc
• Novant Medical Group, Inc
• Novant Medical Group, Inc
• Novant Medical Group, Inc
• Novant Medical Group, Inc
• Novant Medical Group, Inc
• Novant Medical Group, Inc

• All providers in Charlotte, NC
• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2017; 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.