Novant Health Medical Group, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

NOVANT HEALTH MEDICAL GROUP, LLC

Doing business as

Novant Health Mountainview Medical Extended Care

Practice address

167 Moore Rd Ste 206
King, NC 27021-8770

Phone

(336) 673-6450

Fax

(336) 673-6449

NPI assigned

Feb 21, 2019

Last updated

Jul 9, 2024By the provider in NPPES

Organization subpart

No

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 1

Addresses

Other names 1

• Novant Health Mountainview Medical Extended Care Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 23

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.

• Sarah Voss Berwanger, NP-C

  • Nurse Practitioner
  • King, NC
  • NPI 1255789673
  NPD
• Laurie Reynolds Bowles, RN, NP

  • Nurse Practitioner
  • King, NC
  • NPI 1750690285
  NPD
• G. Laurent Choiniere, NP, PHD, LPC

  • Nurse Practitioner
  • Greensboro, NC
  • NPI 1013949759
  NPD
• Vanessa Renee Church, NURSE PRACTITIONER

  • Gerontology Nurse Practitioner
  • Pilot Mountain, NC
  • NPI 1235894056
  NPD
• Terry Michael Deakle, PA

  • Physician Assistant
  • Clemmons, NC
  • NPI 1326028382
  NPD
• Emily Marion Fischer, NP-C

  • Nurse Practitioner
  • King, NC
  • NPI 1235612813
  NPD
• William Alexander Graham IV, M.D.

  • Family Medicine Physician
  • King, NC
  • NPI 1659487981
  NPD
• Judy Hawks Grove, FNP

  • Nurse Practitioner
  • King, NC
  • NPI 1720732084
  NPD
• Amber Moser Hairford, M.D.

  • Family Medicine Physician
  • King, NC
  • NPI 1124389796
  NPD
• Renee Childress Haynes, FNP-C

  • Nurse Practitioner
  • Clemmons, NC
  • NPI 1477994507
  NPD
• Ashley Nicole Holder, NP-C

  • Nurse Practitioner
  • King, NC
  • NPI 1962095513
  NPD
• Deborah Jackson James

  • Nurse Practitioner
  • King, NC
  • NPI 1881995371
  NPD

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

{
    "created_epoch": "1550707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720483200000",
    "number": "1245797745",
    "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": "167 MOORE RD STE 206",
            "city": "KING",
            "state": "NC",
            "postal_code": "270218770",
            "telephone_number": "336-673-6450",
            "fax_number": "336-673-6449"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "167 Moore Rd Ste 201",
            "address_purpose": "LOCATION",
            "city": "King",
            "state": "NC",
            "postal_code": "270218770",
            "country_code": "US",
            "telephone_number": "336-983-4346",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NOVANT HEALTH MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-21",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "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": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Mountainview Medical Extended Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jody Lynn Nash, LPCA, LCASA
• Austin Newsom, PHARMD
• Samuel Carl Newsome, MD
• James Corey Norman
• North Carolina CVS Pharmacy LLC (CVS Pharmacy #07354)
• Novant Health Medical Group, LLC (Novant Health Orthopedics & Sports Medicine)
• Novant Health Medical Group, LLC (Novant Health Pediatric Cardiology)
• Novant Health Medical Group, LLC (Novant Health Pediatrics King)
• Novant Health Stokes Medical Center, LLC (Medical Center of King)
• Novant Medical Group Inc (Novant Health Carolina Urological Associates)

• Family Medicine Physician in King, NC
• Providers in King, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.