Novant Health Medical Group, LLC
Organization Active NPI Urology Physician · Carolina Shores, NC
NPI 1356705479 · NPPES record last updated Jun 21, 2024
Key facts
- NPI
- 1356705479
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Urology Physician 208800000X
- Legal business name
- NOVANT HEALTH MEDICAL GROUP, LLC
- Practice address
- 75 Emerson Bay Rd
Suite 102
Carolina Shores, NC 28467-2498 - Phone
- (910) 721-4000
- NPI assigned
- Apr 6, 2016
- Organization subpart
- No
Authorized official
- Name
- Leea Jeanine Walton
- Title
- RCS Manager
- Phone
- (704) 316-6081
Corporate family (same tax ID) 24
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D2112910 | Novant Health Urology Partners | Certificate of waiver | May 10, 2028 |
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
- Tax ID family
- Presbyterian Inpt Care
Locations
75 Emerson Bay Rd
#102
Carolina Shores, NC 28467
Phone (910) 579-8363
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician |
208800000X | Yes |
Addresses
Primary practice location
75 Emerson Bay Rd
Suite 102
Carolina Shores, NC 28467-2498
Mailing address
PO Box 60447
Charlotte, NC 28260-0447
Phone (910) 721-4000
Other names
- Novant Health Urology Partners
Other providers in Carolina Shores, NC
- Stephen Bruce Jones
- Level Up Physical Therapy Inc
- Ross Alden Lippard
- Novant Health Medical Group Coastal Region, LLC
- Novant Health Medical Group Coastal Region, LLC
- Novant Health Medical Group, LLC
- Don J Olivero
- Ashlee Pinion-Raby
- Anne Marie Rakip
- Riccobene & Associates I, DDS, P.a.
All providers in Carolina Shores, NC · Urology 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 Jun 21, 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.