Novant Health Medical Group, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

NOVANT HEALTH MEDICAL GROUP, LLC

Doing business as

Novant Health Diabetes Management

Practice address

1400 Westgate Center Drive
Suite 130
Winston Salem, NC 27103-3104

Phone

(336) 659-8703

Fax

(336) 659-8704

NPI assigned

Sep 23, 2016

Last updated

Jul 10, 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 1

Addresses

Other names 1

• Novant Health Diabetes Management 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.

• Sandy B Adcock, NP

  • Nurse Practitioner
  • Kernersville, NC
  • NPI 1447238662
  NPD
• Liliana Pitu, NP-C

  • Nurse Practitioner
  • Winston Salem, NC
  • NPI 1942779475
  NPD
• Sakeitha L'Tia Crowder, MD

  • Internal Medicine Physician
  • Winston Salem, NC
  • NPI 1356511216
  NPD (past)
• Kaleigh Elise Mikolichek, PHARMD

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Charlotte, NC
  • NPI 1588407746
  NPD (past)
• Selby Gage Rouch, PA-C

  • Physician Assistant
  • Winston Salem, NC
  • NPI 1376005942
  NPD (past)
• Jessica Rose Walukonis, PA-C

  • Physician Assistant
  • Thomasville, NC
  • NPI 1770248627
  NPD (past)

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

{
    "created_epoch": "1474588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720569600000",
    "number": "1376092056",
    "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": "336-659-8703",
            "fax_number": "336-659-8704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 WESTGATE CENTER DRIVE",
            "address_2": "SUITE 130",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271033104",
            "telephone_number": "336-659-8703",
            "fax_number": "336-659-8704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT HEALTH MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-23",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "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": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Diabetes Management",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Novant Health Medical Group, LLC (Novant Health Physical Medicine & Rehab)
• Novant Health Medical Group, LLC (Novant Health Adult Primary Care Peters Creek)
• Novant Health Medical Group, LLC (Novant Health Maternal-Fetal Medicine)
• Novant Health Medical Group, LLC (Novant Health Inpatient Critical Care)
• Novant Health Medical Group, LLC (Novant Health Senior Living Primary Care)
• Novant Health Medical Group, LLC (Novant Health Arbor Pediatrics)
• Novant Health Medical Group, LLC (Novant Health Today's Pediatrics)
• Novant Health Medical Group, LLC (Novant Health Cardiothoracic Surgeons)
• Novant Health Medical Group, LLC (Novant Health Foot and Ankle)
• Novant Health Medical Group, LLC (Novant Health Waughtown Pediatrics)

• Internal Medicine Physician in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 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.