Novant Medical Group Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

NOVANT MEDICAL GROUP INC

Doing business as

Brunswick Primary Care

Practice address

18 Doctors Cir
Suite 2
Supply, NC 28462-4089

Phone

(910) 755-6802

Fax

(910) 755-6804

NPI assigned

May 3, 2006

Last updated

Jun 2, 2009By 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

Dinesh S. Pai

Title

VP of Operations

Phone

(704) 384-9104

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Brunswick Primary Care Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243900800000",
    "number": "1497713986",
    "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": "910-755-6802",
            "fax_number": "910-755-6804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 DOCTORS CIR",
            "address_2": "SUITE 2",
            "city": "SUPPLY",
            "state": "NC",
            "postal_code": "284624089",
            "telephone_number": "910-755-6802",
            "fax_number": "910-755-6804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-03",
        "last_updated": "2009-06-02",
        "status": "A",
        "authorized_official_last_name": "PAI",
        "authorized_official_first_name": "DINESH",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "704-384-9104"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5903336",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brunswick Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Novant Health Brunswick Endoscopy Center, LLC (Novant Health Brunswick Endoscopy)
• Novant Health Medical Group LLC (Novant Health Gastroenterology Brunswick)
• Novant Health Medical Group, LLC (Novant Health Orthopedics & Sports Medicine)
• Novant Health Medical Group, LLC (Novant Health Pediatrics Brunswick)
• Novant Health Medical Group, LLC
• Novant Medical Group Inc (Brunswick Coast Pediatrics)
• Novant Medical Group, Inc. (Calabash Internal Medicine)
• Nicole Emily Nyberg, N.P.
• Oceanic Infinite Home Care
• Patricia Grace Oconnor, SLP

• Family Medicine Physician in Supply, NC
• Providers in Supply, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2009; 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.