Novant Health Medical Group, LLC

Primary specialty

Dermatopathology PhysicianTaxonomy code 207ND0900X

Legal business name

NOVANT HEALTH MEDICAL GROUP, LLC

Doing business as

Novant Health Northlake Dermatology

Practice address

9604 Holly Point Dr
Huntersville, NC 28078-4913

Phone

(704) 316-5070

Fax

(704) 316-5075

NPI assigned

Jul 31, 2006

Last updated

Jun 19, 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 2

Addresses

Other names 1

• Novant Health Northlake Dermatology 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.

• Melinda Ruth Asfaw, PA-C

  • Physician Assistant
  • Huntersville, NC
  • NPI 1568524023
  NPD
• Eric Alan Knuth, PA-C

  • Physician Assistant
  • Huntersville, NC
  • NPI 1992259378
  NPD
• Jose Raul Pena, M.D.

  • Dermatology Physician
  • Huntersville, NC
  • NPI 1598741563
  NPD
• Regina Plohal, FNP

  • Nurse Practitioner
  • Huntersville, NC
  • NPI 1932637634
  NPD
• Sonia Lau Sebastiano, P.A.-C

  • Physician Assistant
  • Charlotte, NC
  • NPI 1386692408
  NPD
• Melissa Diane Wriglesworth, PA

  • Physician Assistant
  • Huntersville, NC
  • NPI 1417438839
  NPD

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718755200000",
    "number": "1396751640",
    "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": "704-316-5070",
            "fax_number": "704-316-5075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9604 HOLLY POINT DR",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280784913",
            "telephone_number": "704-316-5070",
            "fax_number": "704-316-5075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT HEALTH MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-31",
        "last_updated": "2024-06-19",
        "certification_date": "2024-06-19",
        "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": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Northlake Dermatology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Novant Health Northlake Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Novant Health Medical Group, LLC (Novant Health Spine & Headache Rehabilitation)
• Novant Health Medical Group, LLC (Novant Health Sleep Medicine)
• Novant Health Medical Group, LLC (Novant Health Orthopedics & Sports Medicine)
• Novant Health Medical Group, LLC (Novant Health Brain and Spine Surgery)
• Novant Health Medical Group, LLC (Novant Health Endocrine and Thyroid)
• Novant Health Medical Group, LLC (Novant Health Psychiatric Associates)
• Novant Health Medical Group, LLC (Novant Health Sleep Center)
• Novant Health Medical Group, LLC (Novant Health Inpatient Care Specialists Huntesville)
• Novant Health Medical Group, LLC (NHMG Psychiatric Clinics)
• Novant Health Medical Group, LLC (NHMG Specialty Clinics)

• Dermatopathology Physician in Huntersville, NC
• Providers in Huntersville, NC by specialty
• Dermatopathology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 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.