Novant Health Medical Group, LLC
Organization Active NPI Internal Medicine Physician · Winston Salem, NC
NPI 1285409672 · NPPES record last updated Jul 8, 2024
Key facts
- NPI
- 1285409672
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- NOVANT HEALTH MEDICAL GROUP, LLC
- Practice address
- 5038 Peters Creek Pkwy Ste 150
Winston Salem, NC 27127-7172 - Phone
- (336) 277-2710
- Fax
- (336) 277-2719
- NPI assigned
- Nov 16, 2023
- Organization subpart
- No
Authorized official
- Name
- Leea Jeanine Walton
- Title
- RSC Manager
- Phone
- (336) 515-7085
Corporate family (same tax ID) 24
Practitioners 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D2296636 | Novant Health Adult Primary Care Peters Creek | Certificate of waiver | Jan 2, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| 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
- Tax ID family
- Presbyterian Inpt Care
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes |
Addresses
Primary practice location
5038 Peters Creek Pkwy Ste 150
Winston Salem, NC 27127-7172
Mailing address
PO Box 60447
Charlotte, NC 28260-0447
Other names
- Novant Health Adult Primary Care Peters Creek
Other providers in Winston Salem, NC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
All providers in Winston Salem, NC · Internal Medicine Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.