Novant Health Medical Group, LLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

NOVANT HEALTH MEDICAL GROUP, LLC

Practice address

257 Hospital Drive Suite 200
Bolivia, NC 28422-8411

Phone

(910) 721-4000

Fax

(910) 721-4001

NPI assigned

Oct 16, 2006

Organization subpart

No

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

Addresses

Other identifiers 4

Other names 1

• Novant Health Surgical Associates Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 1

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

• Alex Grayson Fletcher

  • Surgery Physician
  • Bolivia, NC
  • NPI 1184186611

  Surgery

  NPD

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719187200000",
    "number": "1336229384",
    "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": "910-721-4000",
            "fax_number": "910-721-4001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "257 HOSPITAL DRIVE SUITE 200",
            "city": "BOLIVIA",
            "state": "NC",
            "postal_code": "284228411",
            "telephone_number": "910-721-4000",
            "fax_number": "910-721-4001"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "584 Hospital Dr NE",
            "address_2": "Suite A",
            "address_purpose": "LOCATION",
            "city": "Bolivia",
            "state": "NC",
            "postal_code": "284229047",
            "country_code": "US",
            "telephone_number": "910-721-4000",
            "fax_number": "910-721-4001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NOVANT HEALTH MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-16",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "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": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CC5118",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NPB268",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS-NC",
            "identifier": "018M5",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5905547",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Surgical Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Novant Health Surgical Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Bolivia, NC
• Surgery Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2024; 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.