Active NPI
Novant Health Medical Group, LLC
Doing business as Novant Health Gastroenterology
- Gastroenterology Physician
- Mooresville, NC
National Provider Identifier
1538915103
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- Legal business name
- NOVANT HEALTH MEDICAL GROUP, LLC
- Doing business as
- Novant Health Gastroenterology
- Practice address
- 106 Alexander Bank Dr Ste 200
Mooresville, NC 28117-9624 - Phone
- (704) 660-2622
- Fax
- (704) 660-2633
- NPI assigned
- Apr 25, 2024
- Organization subpart
- No
NPPES NPI Registry
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
- (336) 515-7085
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | Primary |
Addresses
Primary practice location
106 Alexander Bank Dr Ste 200
Mooresville, NC 28117-9624
Mailing address
PO Box 60447
Charlotte, NC 28260-0447
Other names 1
- Novant Health Gastroenterology
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1714003200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1714608000000",
"number": "1538915103",
"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"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "106 ALEXANDER BANK DR STE 200",
"city": "MOORESVILLE",
"state": "NC",
"postal_code": "281179624",
"telephone_number": "704-660-2622",
"fax_number": "704-660-2633"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NOVANT HEALTH MEDICAL GROUP, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2024-04-25",
"last_updated": "2024-05-02",
"certification_date": "2024-05-02",
"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": "336-515-7085"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine, Gastroenterology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Novant Health Gastroenterology",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Mooresville, NC
- Novant Health Medical Group, LLC (Lake Norman Medical Group, Primary Care Morrison Plantation)
- Novant Health Medical Group, LLC (Novant Health Heart & Vascular Institute)
- Novant Health Medical Group, LLC (Novant Health Pediatrics & Internal Medicine Gateway)
- Novant Health Medical Group, LLC (Novant Health Primary Care Byers Creek)
- Novant Health Medical Group, LLC (Novant Health Neurology)
- Novant Health Medical Group, LLC (Novant Health Pediatrics Lake Norman)
- Novant Health Medical Group, LLC (Novant Health General Surgery & Bariatrics)
- Novant Health Medical Group, LLC (Novant Health Internal Medicine Gateway)
- Novant Health Medical Group, LLC (Novant Health Family Medicine Tall Oaks)
- Novant Health Medical Group, LLC (Lake Norman Medical Group, Family Medicine Tall Oaks)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 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.