Novant Health Medical Group, LLC

Primary specialty

Sports Medicine (Internal Medicine) PhysicianTaxonomy code 207RS0010X

Legal business name

NOVANT HEALTH MEDICAL GROUP, LLC

Doing business as

Novant Health Arboretum Family and Sports Medicine

Practice address

7903 Providence Rd
Suite 100
Charlotte, NC 28277-9720

Phone

(704) 316-4460

Fax

(704) 316-4466

NPI assigned

Dec 19, 2011

Last updated

Jul 8, 2024By the provider in NPPES

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 2

Addresses

Other names 1

• Novant Health Arboretum Family and Sports Medicine Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Eno-Obong Effiong

  • Hospitalist Physician
  • Monroe, NC
  • NPI 1306466198

  Internal Medicine

  NPD
• Sarah Billings Hogge, NP

  • Nurse Practitioner
  • Charlotte, NC
  • NPI 1457018772
  NPD
• Travis Worth Howell, M.D.

  • Family Medicine Physician
  • Clemmons, NC
  • NPI 1346208113
  NPD
• Brian Christopher Ingold, DO

  • Family Medicine Physician
  • Charlotte, NC
  • NPI 1295399871
  NPD
• Benjamin James Missick, M.D.

  • Family Medicine Physician
  • Charlotte, NC
  • NPI 1457557548
  NPD
• Susannah Bauer Van Dyke, NP

  • Nurse Practitioner
  • Charlotte, NC
  • NPI 1801917703
  NPD

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

{
    "created_epoch": "1324252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720396800000",
    "number": "1346519451",
    "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": "704-316-4460",
            "fax_number": "704-316-4466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7903 PROVIDENCE RD",
            "address_2": "SUITE 100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282779720",
            "telephone_number": "704-316-4460",
            "fax_number": "704-316-4466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT HEALTH MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-19",
        "last_updated": "2024-07-08",
        "certification_date": "2024-07-08",
        "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": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Sports Medicine",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Arboretum Family and Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Sports Medicine (Internal Medicine) Physician in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Sports Medicine (Internal Medicine) Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.