NPIMap

Organization Active NPI

Novant Health Medical Group, LLC

  • Endocrinology, Diabetes & Metabolism Physician
  • Charlotte, NC
National Provider Identifier
1306950282
Registry record updated Jul 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
Legal business name
NOVANT HEALTH MEDICAL GROUP, LLC
Practice address
1918 Randolph Rd
Suite 220
Charlotte, NC 28207-1109
Phone
(704) 316-1125
Fax
(704) 316-1143
NPI assigned
Aug 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2024

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

Authorized official

Name
Leea Jeanine Walton
Title
RCS Manager
Phone
(704) 316-6081

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RE0101X Primary

Addresses

Primary practice location

1918 Randolph Rd
Suite 220
Charlotte, NC 28207-1109

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 316-1125

Other identifiers 4

IdentifierTypeStateIssuer
CC5118OtherNCRAILROAD MEDICARE
0277FOtherNCBCBS NC
790277FMedicaidNC
NPA896MedicaidSC

Other names 1

  • Novant Health Endocrinology Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

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
O20040204001028 NC Part B Supplier - Clinic/Group Practice 1153234893 Receives reassigned benefits from 648 practitioners
Practice locations: Denver, NC; High Point, NC; Huntersville, NC; Indian Trail, NC; Matthews, NC; Monroe, NC; Mooresville, NC; Salisbury, NC…

Other NPIs with the same Medicare PAC ID 13

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 13

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D0989562Novant Health Endocrinology1918 Randolph Road, Suite 220, Charlotte, NC 28207ComplianceApr 29, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 677

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

View all 677

NPI Registry JSON

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720656000000",
    "number": "1306950282",
    "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": "704-316-1125",
            "fax_number": "704-316-1143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1918 RANDOLPH RD",
            "address_2": "SUITE 220",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282071109",
            "telephone_number": "704-316-1125",
            "fax_number": "704-316-1143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT HEALTH MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-18",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A",
        "authorized_official_last_name": "WALTON",
        "authorized_official_first_name": "LEEA",
        "authorized_official_middle_name": "JEANINE",
        "authorized_official_title_or_position": "RCS MANAGER",
        "authorized_official_telephone_number": "704-316-6081"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CC5118",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NC",
            "identifier": "0277F",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "790277F",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NPA896",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Endocrinology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Novant Health Endocrinology",
            "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 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.