NPIMap

Organization Active NPI

Novant Health Medical Group, LLC

Doing business as Novant Health Pediatric Pulmonology

  • Pediatric Pulmonology Physician
  • Charlotte, NC
National Provider Identifier
1417477977
Registry record updated Jun 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Pulmonology PhysicianTaxonomy code 2080P0214X
Legal business name
NOVANT HEALTH MEDICAL GROUP, LLC
Doing business as
Novant Health Pediatric Pulmonology
Practice address
201 Queens Rd
Charlotte, NC 28204-3217
Phone
(704) 316-5280
Fax
(704) 316-5282
NPI assigned
Jun 26, 2017
Last updated
Jun 14, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2024

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

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Pulmonology Physician 2080P0214X Primary

Addresses

Primary practice location

201 Queens Rd
Charlotte, NC 28204-3217

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 316-5280

Other practice location 1

1918 Randolph Rd Ste 700
Charlotte, NC 28207-1167
Phone (704) 384-1056

Other names 1

  • Novant Health Pediatric Pulmonology Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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 Directory
Tax ID family
Presbyterian Inpt Care504 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1498435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718323200000",
    "number": "1417477977",
    "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": "704-316-5280",
            "fax_number": "704-316-5282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 QUEENS RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282043217",
            "telephone_number": "704-316-5280",
            "fax_number": "704-316-5282"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1918 Randolph Rd Ste 700",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282071167",
            "country_code": "US",
            "telephone_number": "704-384-1056",
            "fax_number": "704-384-1046",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NOVANT HEALTH MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-26",
        "last_updated": "2024-06-14",
        "certification_date": "2024-06-14",
        "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": "2080P0214X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Pediatric Pulmonology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Novant Health Pediatric Pulmonology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2024; 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.

Verify at the official NPI Registry.