Novant Health Medical Group, LLC
Organization Active NPI Family Medicine Physician · Charlotte, NC
NPI 1346548898 · NPPES record last updated Jul 9, 2024
Key facts
- NPI
- 1346548898
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- NOVANT HEALTH MEDICAL GROUP, LLC
- Practice address
- 8420 University Exec Park Dr Ste 850
Charlotte, NC 28262-1308 - Phone
- (704) 384-1225
- Fax
- (704) 384-1226
- NPI assigned
- Mar 8, 2011
- Organization subpart
- No
Authorized official
- Name
- Leea Jeanine Walton
- Title
- RCS Manager
- Phone
- (704) 316-6081
Practitioners 13
-
Jennifer Starnes Martyak, MSN, NP-C
-
Leena Jemba Mitchell, FNP-C
-
Leela Madhuri Reddy, M.D.
-
Yeng Yang, DO
-
Guangbin Zeng, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D2021841 | Novant Health Prosperity Family Physicians | Certificate of waiver | Feb 23, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040204001028 | NC | Part B Supplier - Clinic/Group Practice | 1153234893 |
Receives reassigned benefits from 648 practitioners This NPI is an additional NPI on the enrollment Practice locations: Denver, NC; High Point, NC; Huntersville, NC; Indian Trail, NC; Matthews, NC; Monroe, NC; Mooresville, NC; Salisbury, NC… |
National Provider Directory
Locations
515 Lake Concord Rd NE
Concord, NC 28025
Phone (704) 784-4494
600 Fullwood Rd
Matthews, NC 28105
Phone (704) 841-4920
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
8420 University Exec Park Dr Ste 850
Charlotte, NC 28262-1308
Mailing address
PO Box 60447
Charlotte, NC 28260-0447
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5918729 | Medicaid | NC |
Other names
- Novant Health Prosperity Family Physicians
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 · Family 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 9, 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.