NPIMap

Organization Active NPI

Novant Health Medical Group, LLC

Doing business as Novant Health Orthopedics & Sports Medicine

  • Orthopaedic Surgery Physician
  • Cornelius, NC
National Provider Identifier
1215179296
Registry record updated Jul 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
NOVANT HEALTH MEDICAL GROUP, LLC
Doing business as
Novant Health Orthopedics & Sports Medicine
Practice address
19485 Old Jetton Rd
Suite 210
Cornelius, NC 28031-6592
Phone
(704) 316-1830
Fax
(704) 316-1835
NPI assigned
Apr 6, 2009
Last updated
Jul 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X Primary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X

Addresses

Primary practice location

19485 Old Jetton Rd
Suite 210
Cornelius, NC 28031-6592

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 316-1830

Other practice location 1

6909 Prosperity Church Rd
Huntersville, NC 28078-6698
Phone (704) 384-1680

Other practice location 2

130 Plantation Ridge Dr
Ste 100
Mooresville, NC 28117-9238
Phone (704) 384-1775

Other identifiers 1

IdentifierTypeStateIssuer
5911479MedicaidNC

Other names 1

  • Novant Health Orthopedics & Sports Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040204001028 NC Part B Supplier - Clinic/Group Practice 1153234893 Receives reassigned benefits from 648 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Denver, NC; High Point, NC; Huntersville, NC; Indian Trail, NC; Matthews, NC; Monroe, NC; Mooresville, NC; Salisbury, NC…

National Provider Directory

National Provider Directory

Locations

106 Langtree Village Dr
Ste 200
Mooresville, NC 28117
Phone (704) 316-5570

Practitioners & affiliated clinicians

Practitioners 20

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.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1238976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720656000000",
    "number": "1215179296",
    "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": "704-316-1830",
            "fax_number": "704-316-1835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19485 OLD JETTON RD",
            "address_2": "SUITE 210",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280316592",
            "telephone_number": "704-316-1830",
            "fax_number": "704-316-1835"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6909 Prosperity Church Rd",
            "address_purpose": "LOCATION",
            "city": "Huntersville",
            "state": "NC",
            "postal_code": "280786698",
            "country_code": "US",
            "telephone_number": "704-384-1680",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "130 Plantation Ridge Dr",
            "address_2": "Ste 100",
            "address_purpose": "LOCATION",
            "city": "Mooresville",
            "state": "NC",
            "postal_code": "281179238",
            "country_code": "US",
            "telephone_number": "704-384-1775",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NOVANT HEALTH MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-06",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "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": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5911479",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Orthopedics & Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Novant Health Orthopedics & Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cornelius, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 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.