Active NPI
Novant Medical Group, Inc.
- Family Medicine Physician
- Louisburg, NC
National Provider Identifier
1235385915
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- NOVANT MEDICAL GROUP, INC.
- Practice address
- 205 Sandalwood Ave
Suite C
Louisburg, NC 27549-2679 - Phone
- (919) 496-5774
- Fax
- (919) 496-2311
- NPI assigned
- Aug 13, 2008
- Organization subpart
- Yes
- Parent organization
- NOVANT MEDICAL GROUP, INC.
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Geoffrey Gardner
- Title
- VP of Operations
- Phone
- (919) 496-5774
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
205 Sandalwood Ave
Suite C
Louisburg, NC 27549-2679
Mailing address
PO Box 60447
Charlotte, NC 28260-0447
Phone (919) 496-5774
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5912768 | Medicaid | NC |
Other names 1
- Novant Heatlh Franklin Family Medicine
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 Directory- Part of
- Presbyterian Inpt Care
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1218585600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1385683200000",
"number": "1235385915",
"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": "919-496-5774",
"fax_number": "919-496-2311"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 SANDALWOOD AVE",
"address_2": "SUITE C",
"city": "LOUISBURG",
"state": "NC",
"postal_code": "275492679",
"telephone_number": "919-496-5774",
"fax_number": "919-496-2311"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NOVANT MEDICAL GROUP, INC.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "NOVANT MEDICAL GROUP, INC.",
"enumeration_date": "2008-08-13",
"last_updated": "2013-11-29",
"status": "A",
"authorized_official_last_name": "GARDNER",
"authorized_official_first_name": "GEOFFREY",
"authorized_official_title_or_position": "VP OF OPERATIONS",
"authorized_official_telephone_number": "919-496-5774"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5912768",
"state": "NC"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Novant Heatlh Franklin Family Medicine",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Louisburg, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2013; 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.