Active NPI
Novant Medical Group, Inc
- Family Medicine Physician
- Charlotte, NC
National Provider Identifier
1306140397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- NOVANT MEDICAL GROUP, INC
- Practice address
- 1918 Randolph Rd
Suite 175
Charlotte, NC 28207-1100 - Phone
- (704) 316-1050
- Fax
- (704) 316-1051
- NPI assigned
- Jan 5, 2011
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Geoffrey Gardner
- Title
- VP Finance
- Phone
- (704) 384-9490
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | |||
| Family Medicine Physician | 207Q00000X | Primary | ||
| Urgent Care Clinic/Center | 261QU0200X |
Addresses
Primary practice location
1918 Randolph Rd
Suite 175
Charlotte, NC 28207-1100
Mailing address
PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 384-7840
Other names 1
- Presbyterian Urgent Care
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
| 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
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1294185600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1304467200000",
"number": "1306140397",
"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": "1918 RANDOLPH RD",
"address_2": "SUITE 175",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282071100",
"telephone_number": "704-316-1050",
"fax_number": "704-316-1051"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NOVANT MEDICAL GROUP, INC",
"organizational_subpart": "NO",
"enumeration_date": "2011-01-05",
"last_updated": "2011-05-04",
"status": "A",
"authorized_official_last_name": "GARDNER",
"authorized_official_first_name": "GEOFFREY",
"authorized_official_title_or_position": "VP FINANCE",
"authorized_official_telephone_number": "704-384-9490",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Emergency Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "261QU0200X",
"taxonomy_group": "",
"desc": "Clinic/Center, Urgent Care",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Presbyterian Urgent Care",
"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 4, 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.