NPIMap

Organization Active NPI

Novus Healthcare Group, LLC

  • Family Medicine Physician
  • Spring Park, MN
National Provider Identifier
1346581485
Registry record updated Apr 16, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
NOVUS HEALTHCARE GROUP, LLC
Practice address
4004 Shoreline Dr
Spring Park, MN 55384-9656
Phone
(612) 242-9517
NPI assigned
Mar 14, 2013
Last updated
Apr 16, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2017

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

Authorized official

Name
Mr. Damon Kenton
Title
C.E.O.
Phone
(612) 242-9517

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

4004 Shoreline Dr
Spring Park, MN 55384-9656

Mailing address

4004 Shoreline Dr
Spring Park, MN 55384-9656
Phone (612) 242-9517

National Provider Directory

National Provider Directory

Locations

60 Gillett St
Ste 402
Hartford, CT 06105
Phone (860) 233-0112

4004 Shoreline Dr
Spring Park, MN 55384
Phone (952) 300-3328

4701 Devonshire Rd
Harrisburg, PA 17109
Phone (717) 379-0076

Practitioners & affiliated clinicians

Practitioners 23

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.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1363219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492300800000",
    "number": "1346581485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4004 SHORELINE DR",
            "city": "SPRING PARK",
            "state": "MN",
            "postal_code": "553849656",
            "telephone_number": "612-242-9517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4004 SHORELINE DR",
            "city": "SPRING PARK",
            "state": "MN",
            "postal_code": "553849656",
            "telephone_number": "612-242-9517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVUS HEALTHCARE GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-14",
        "last_updated": "2017-04-16",
        "status": "A",
        "authorized_official_last_name": "KENTON",
        "authorized_official_first_name": "DAMON",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "612-242-9517",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spring Park, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.