Active NPI
Novant Medical Group Inc
Doing business as Calabretta Cosmetic Surgery Center
- Plastic Surgery Physician
- Charlotte, NC
National Provider Identifier
1366683138
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic Surgery Physician
- Legal business name
- NOVANT MEDICAL GROUP INC
- Doing business as
- Calabretta Cosmetic Surgery Center
- Practice address
- 1918 Randolph Rd
Suite 850
Charlotte, NC 28207-1100 - Phone
- (704) 444-5800
- Fax
- (704) 444-5819
- NPI assigned
- Mar 9, 2009
- Last updated
- Apr 20, 2010
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Geoffrey K. Gardner
- Title
- VP of Finance
- Phone
- (704) 384-9094
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery Physician | 208200000X | NU | Primary |
Addresses
Primary practice location
1918 Randolph Rd
Suite 850
Charlotte, NC 28207-1100
Mailing address
PO Box 602362
Charlotte, NC 28260-2362
Phone (704) 444-5800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5911267 | Medicaid | NC |
Other names 1
- Calabretta Cosmetic Surgery Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
| 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
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1236556800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1271721600000",
"number": "1366683138",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 602362",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282602362",
"telephone_number": "704-444-5800",
"fax_number": "704-444-5819"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1918 RANDOLPH RD",
"address_2": "SUITE 850",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282071100",
"telephone_number": "704-444-5800",
"fax_number": "704-444-5819"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NOVANT MEDICAL GROUP INC",
"organizational_subpart": "NO",
"enumeration_date": "2009-03-09",
"last_updated": "2010-04-20",
"status": "A",
"authorized_official_last_name": "GARDNER",
"authorized_official_first_name": "GEOFFREY",
"authorized_official_middle_name": "K.",
"authorized_official_title_or_position": "VP OF FINANCE",
"authorized_official_telephone_number": "704-384-9094"
},
"taxonomies": [
{
"code": "208200000X",
"taxonomy_group": "",
"desc": "Plastic Surgery",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5911267",
"state": "NC"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Calabretta Cosmetic Surgery Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Charlotte, NC
- Novant Medical Group Inc (Novant Health Rheumatology and Arthritis)
- Novant Medical Group Inc (Novant Health Neurology and Sleep)
- Novant Medical Group Inc (Novant Health Pediatrics Arboretum)
- Novant Medical Group Inc (Novant Health Sleep Center)
- Novant Medical Group Inc (Novant Health Pediatric Pulmonology)
- Novant Medical Group Inc (Novant Health Psychiatric Associates)
- Novant Medical Group Inc (Novant Health Neurology and Sleep)
- Novant Medical Group Inc (Novant Health Sleep Center)
- Novant Medical Group Inc (Novant Health Sleep Center)
- Novant Medical Group Inc (Calabretta Cosmetic Surgery Center)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.