Active NPI
Novant Medical Group, Inc
- Psychiatry Physician
- Charlotte, NC
National Provider Identifier
1174053086
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- Legal business name
- NOVANT MEDICAL GROUP, INC
- Practice address
- 335 N Caswell Rd
Charlotte, NC 28204-2470 - Phone
- (704) 384-7980
- Fax
- (704) 384-7985
- NPI assigned
- Jun 13, 2017
- 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
- Shala Davis
- Title
- RCS Manager
- Phone
- (704) 303-7517
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | Primary |
Addresses
Primary practice location
335 N Caswell Rd
Charlotte, NC 28204-2470
Mailing address
PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 384-7980
Other names 1
- Novant Health Psychiatric Integrated Care
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 DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1497312000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1629158400000",
"number": "1174053086",
"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": "704-384-7980",
"fax_number": "704-384-7985"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "335 N CASWELL RD",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282042470",
"telephone_number": "704-384-7980",
"fax_number": "704-384-7985"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NOVANT MEDICAL GROUP, INC",
"organizational_subpart": "NO",
"enumeration_date": "2017-06-13",
"last_updated": "2021-08-17",
"certification_date": "2021-08-17",
"status": "A",
"authorized_official_last_name": "DAVIS",
"authorized_official_first_name": "SHALA",
"authorized_official_title_or_position": "RCS MANAGER",
"authorized_official_telephone_number": "704-303-7517"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Novant Health Psychiatric Integrated Care",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Novant Health Psychiatric Integrated Care",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2021; 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.