NPIMap

Organization Active NPI

Novant Health Medical Group, LLC

Doing business as Novant Health Brain and Spine Surgery

  • Neurological Surgery Physician
  • Winston Salem, NC
National Provider Identifier
1497080006
Registry record updated Jun 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
Legal business name
NOVANT HEALTH MEDICAL GROUP, LLC
Doing business as
Novant Health Brain and Spine Surgery
Novant Health Forsyth Brain and Spine Surgery
Practice address
190 Kimel Park Dr Ste 155
Winston Salem, NC 27103-6946
Phone
(336) 765-6637
Fax
(336) 765-6964
NPI assigned
Oct 15, 2009
Last updated
Jun 20, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 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
Neurological Surgery Physician 207T00000X NU Primary

Addresses

Primary practice location

190 Kimel Park Dr Ste 155
Winston Salem, NC 27103-6946

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (336) 765-6637

Other names 2

  • Novant Health Brain and Spine Surgery Doing business as
  • Novant Health Forsyth Brain and Spine Surgery Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC2 enrollments

Enrollment records 2

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
O20121217000436 NC DME Supplier - Physician - Neurology 1153234893 Practice locations: Winston Salem, NC

Other NPIs with the same Medicare PAC ID 13

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 13

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

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": "1255564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718841600000",
    "number": "1497080006",
    "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": "336-765-6637",
            "fax_number": "336-765-6964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 KIMEL PARK DR STE 155",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036946",
            "telephone_number": "336-765-6637",
            "fax_number": "336-765-6964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT HEALTH MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-15",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "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": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Brain and Spine Surgery",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Novant Health Forsyth Brain and Spine Surgery",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Novant Health Forsyth Brain and Spine Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 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.