NPIMap

Organization Active NPI

Novant Health Medical Group LLC

Doing business as Novant Health Heart & Vascular - Elizabeth (Vascular Surgery)

  • Vascular Surgery Physician
  • Charlotte, NC
National Provider Identifier
1275480790
Registry record updated May 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
NOVANT HEALTH MEDICAL GROUP LLC
Doing business as
Novant Health Heart & Vascular - Elizabeth (Vascular Surgery)
Practice address
125 Queens Rd Ste 250
Charlotte, NC 28204-3419
Phone
(704) 000-0000
NPI assigned
Mar 13, 2026
Last updated
May 6, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Leea Jeanine Walton
Title
Manager
Phone
(336) 515-7085

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X NU Primary

Addresses

Primary practice location

125 Queens Rd Ste 250
Charlotte, NC 28204-3419

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Other names 1

  • Novant Health Heart & Vascular - Elizabeth (Vascular Surgery) Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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
Tax ID family
Presbyterian Specialty503 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1773360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778025600000",
    "number": "1275480790",
    "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": "125 QUEENS RD STE 250",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282043419",
            "telephone_number": "704-000-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT HEALTH MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-03-13",
        "last_updated": "2026-05-06",
        "certification_date": "2026-05-06",
        "status": "A",
        "authorized_official_last_name": "WALTON",
        "authorized_official_first_name": "LEEA",
        "authorized_official_middle_name": "JEANINE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "336-515-7085"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Heart & Vascular - Elizabeth (Vascular Surgery)",
            "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 May 6, 2026; 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.