NPIMap

Organization Active NPI

Novant Health Medical Group, LLC

  • Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician
  • Winston Salem, NC
National Provider Identifier
1497119283
Registry record updated Jun 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urogynecology and Reconstructive Pelvic Surgery (Urology) PhysicianTaxonomy code 2088F0040X
Legal business name
NOVANT HEALTH MEDICAL GROUP, LLC
Practice address
770 Highland Oaks Dr
Suite 100
Winston Salem, NC 27103
Phone
(336) 718-1970
Fax
(336) 774-7105
NPI assigned
Apr 8, 2016
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Leea Jeanine Walton
Title
RCS Manager
Phone
(704) 316-6081

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

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

Medicare enrollment records 1

Medicare enrollment files
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 Care (503 organizations share this tax ID)

Locations

3515 W Market St
Ste 310
Greensboro, NC 27403
Phone (336) 718-1970

14330 Oakhill Park Ln
Ste 200
Huntersville, NC 28078
Phone (704) 316-1265

Specialties & licenses 3

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Urology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2088F0040X Primary
Colon & Rectal Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208C00000X

Addresses

NPPES NPI Registry

Primary practice location

770 Highland Oaks Dr
Suite 100
Winston Salem, NC 27103

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 384-9672

Other names 1

NPPES NPI Registry
  • Novant Health Pelvic Health Center Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 20, 2024.

{
    "created_epoch": "1460073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718841600000",
    "number": "1497119283",
    "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": "704-384-9672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "770 HIGHLAND OAKS DR",
            "address_2": "SUITE 100",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "27103",
            "telephone_number": "336-718-1970",
            "fax_number": "336-774-7105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT HEALTH MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-08",
        "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": "207VF0040X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2088F0040X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Colon & Rectal Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Pelvic Health Center",
            "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.