NPIMap

Organization Active NPI

Novant Medical Group, Inc

Doing business as Novant Health Multidisciplinary Cancer Clinic

  • Medical Oncology Physician
  • Charlotte, NC
National Provider Identifier
1295089936
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Oncology PhysicianTaxonomy code 207RX0202X
Legal business name
NOVANT MEDICAL GROUP, INC
Doing business as
Novant Health Multidisciplinary Cancer Clinic
Practice address
1718 E 4TH St Ste 105
Charlotte, NC 28204-3193
Phone
(704) 384-5373
Fax
(704) 417-4400
NPI assigned
Nov 2, 2012
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Geoffrey K Gardner
Title
VP of NMG Finance
Phone
(704) 384-5373

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RX0202X NC Primary

Addresses

Primary practice location

1718 E 4TH St Ste 105
Charlotte, NC 28204-3193

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 384-7840

Other names 1

  • Novant Health Multidisciplinary Cancer Clinic 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 Inpt Care504 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

Locations

1718 E 4th St
Ste 105
Charlotte, NC 28204
Phone (704) 384-5373

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1351814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1295089936",
    "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": "704-384-7840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1718 E 4TH ST STE 105",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282043193",
            "telephone_number": "704-384-5373",
            "fax_number": "704-417-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-02",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "GEOFFREY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "VP OF NMG FINANCE",
        "authorized_official_telephone_number": "704-384-5373"
    },
    "taxonomies": [
        {
            "code": "207RX0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Multidisciplinary Cancer Clinic",
            "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 Jul 21, 2022; 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.