Novant Health Medical Group, LLC
Organization Active NPI Sports Medicine (Internal Medicine) Physician · Charlotte, NC
NPI 1346519451 · NPPES record last updated Jul 8, 2024
Key facts
- NPI
- 1346519451
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Sports Medicine (Internal Medicine) Physician 207RS0010X
- Legal business name
- NOVANT HEALTH MEDICAL GROUP, LLC
- Practice address
- 7903 Providence Rd
Suite 100
Charlotte, NC 28277-9720 - Phone
- (704) 316-4460
- Fax
- (704) 316-4466
- NPI assigned
- Dec 19, 2011
- Organization subpart
- No
Authorized official
- Name
- Leea Jeanine Walton
- Title
- RCS Manager
- Phone
- (704) 316-6081
Practitioners 6
-
Travis Worth Howell, M.D.
-
Benjamin James Missick, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D2034897 | Novant Health Arboretum Family and Sports Medicine | Provider-performed microscopy | Aug 2, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| 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
Locations
13523 Plaza Road Ext
Ste 100
Charlotte, NC 28215
1918 Randolph Rd
Ste 700
Charlotte, NC 28207
Phone (704) 342-3544
7752 Gateway Ln NW
Ste 100
Concord, NC 28027
Phone (704) 316-4950
16525 Holly Crest Ln
#150120
Huntersville, NC 28078
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | |||
| Sports Medicine (Internal Medicine) Physician |
207RS0010X | NC | Yes |
Addresses
Primary practice location
7903 Providence Rd
Suite 100
Charlotte, NC 28277-9720
Mailing address
PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 316-4460
Other names
- Novant Health Arboretum Family and Sports Medicine
Other providers in Charlotte, NC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
All providers in Charlotte, NC · Sports Medicine (Internal Medicine) Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.