Novant Medical Group, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

NOVANT MEDICAL GROUP, INC.

Doing business as

Northgate Family Medicine

Practice address

1028 Lee Ann Dr NE
Suite 100
Concord, NC 28025-2903

Phone

(704) 788-1134

Fax

(704) 788-1186

NPI assigned

Feb 6, 2007

Last updated

Jul 19, 2011By 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

Geoffrey Gardner

Title

VP of Operations

Phone

(704) 384-9094

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Northgate Family Medicine Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311033600000",
    "number": "1255470274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 602362",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282602362",
            "telephone_number": "704-384-7840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1028 LEE ANN DR NE",
            "address_2": "SUITE 100",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252903",
            "telephone_number": "704-788-1134",
            "fax_number": "704-788-1186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2011-07-19",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "GEOFFREY",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "704-384-9094"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5906102",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NC",
            "identifier": "018WE",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northgate Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Novant Health Medical Group, LLC (Novant Health South Lake OB/GYN)
• Novant Medical Group Inc (Novant Health Developmental &Behavioral Pediatrics)
• Novant Medical Group Inc (Novant Health Pediatric Neurology)
• Novant Medical Group Inc (Farrington Family Medical Center Kannapolis)
• Novant Medical Group, Inc. (Novant Health Pediatric Endocrinology)
• Novant Medical Group, Inc. (Mid Carolina Cardiology)
• Novant Medical Group, Inc. (Wassel Wound Care)
• Madison Nowicki, MS, LPCA, NCC
• Perla Nunez-Tapia, LCSWA
• Onyemaechi Nwanaji-Enwerem

• Family Medicine Physician in Concord, NC
• Providers in Concord, 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 19, 2011; 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.