NPIMap

Organization Active NPI

Novant Medical Group Inc

  • Registered Dietitian
  • Clemmons, NC
National Provider Identifier
1295092856
Registry record updated Dec 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Legal business name
NOVANT MEDICAL GROUP INC
Practice address
4130 Clemmons Rd
Clemmons, NC 27012-7520
Phone
(336) 277-1890
Fax
(336) 277-1889
NPI assigned
Apr 19, 2012
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Mr. Geoffrey K Gardner
Title
VP Finance, NMG
Phone
(336) 718-6770

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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 Care (503 organizations share this tax ID)

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133V00000X Primary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X

Addresses

NPPES NPI Registry

Primary practice location

4130 Clemmons Rd
Clemmons, NC 27012-7520

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (336) 277-1890

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
1295092856MedicaidNC

Other names 1

NPPES NPI Registry
  • Novant Health Nutrition Solutions Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 18, 2015.

{
    "created_epoch": "1334793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450396800000",
    "number": "1295092856",
    "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": "336-277-1890",
            "fax_number": "336-277-1889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4130 CLEMMONS RD",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270127520",
            "telephone_number": "336-277-1890",
            "fax_number": "336-277-1889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-19",
        "last_updated": "2015-12-18",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "GEOFFREY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "VP FINANCE, NMG",
        "authorized_official_telephone_number": "336-718-6770",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1295092856",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Nutrition Solutions",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clemmons, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2015; 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.