NPIMap

Organization Active NPI

Novant Health Medical Group Coastal Region, LLC

Doing business as New Hanover Medical Group

  • Family Medicine Physician
  • Wilmington, NC
National Provider Identifier
1629654256
Registry record updated Oct 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
NOVANT HEALTH MEDICAL GROUP COASTAL REGION, LLC
Doing business as
New Hanover Medical Group
Novant Health New Hanover Primary Care
Practice address
1960 S 16TH St
Wilmington, NC 28401-6676
Phone
(910) 662-6000
Fax
(910) 341-5164
NPI assigned
Mar 23, 2021
Last updated
Oct 22, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Leea Jeanine Walton
Title
Enrollment Manager
Phone
(336) 515-7085

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

1960 S 16TH St
Wilmington, NC 28401-6676

Mailing address

PO Box 936857
Atlanta, GA 31193-6857

Other practice location 1

510 Carolina Bay Dr Ste 110
Wilmington, NC 28403-2046
Phone (910) 662-6000

Other practice location 2

510 Carolina Bay Dr Ste 110
Wilmington, NC 28403-2046
Phone (910) 662-6000

Other practice location 3

109 Scotts Hill Medical Dr.
Ste 204
Wilmington, NC 28411
Phone (910) 662-6000

Other practice location 4

2000 Brabham Ave
Jacksonville, NC 28546-0201
Phone (910) 376-3030

Other practice location 5

1333 S Dickinson Dr Unit 140
Leland, NC 28451-6434
Phone (910) 662-6600

Other practice location 6

510 Carolina Bay Dr Ste 110
Wilmington, NC 28403-2046
Phone (910) 662-6000

Other practice location 7

7420 Market St
Wilmington, NC 28411-9453
Phone (910) 662-6200

Other practice location 8

5145 S College Rd
Wilmington, NC 28412-2207
Phone (910) 662-6000

Other names 2

  • New Hanover Medical Group Doing business as
  • Novant Health New Hanover Primary Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210408000285 NC Part B Supplier - Clinic/Group Practice 2860809936 Receives reassigned benefits from 798 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Wilmington, NC; Wilmington, NE; Boivia, NC; Bolivia, NC; Burgaw, NC; Carolina Shores, NC; Jacksonville, NC; Leland, NC…

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D0245728Novant Health New Hanover Primary Care1960 S 16TH St, Wilmington, NC 28401AccreditationDec 22, 2027

National Provider Directory

National Provider Directory

Locations

1333 S Dickinson Dr
Unit 140
Leland, NC 28451
Phone (910) 662-6600

5505 Currituck Dr
#100
Wilmington, NC 28403
Phone (910) 662-6000

Practitioners & affiliated clinicians

Practitioners 11

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": "1616457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729555200000",
    "number": "1629654256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 936857",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311936857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1960 S 16TH ST",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284016676",
            "telephone_number": "910-662-6000",
            "fax_number": "910-341-5164"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "510 Carolina Bay Dr Ste 110",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284032046",
            "country_code": "US",
            "telephone_number": "910-662-6000",
            "fax_number": "910-662-9703",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "510 Carolina Bay Dr Ste 110",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284032046",
            "country_code": "US",
            "telephone_number": "910-662-6000",
            "fax_number": "910-662-9703",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "109 Scotts Hill Medical Dr.",
            "address_2": "Ste 204",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "28411",
            "country_code": "US",
            "telephone_number": "910-662-6000",
            "fax_number": "910-341-5164",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2000 Brabham Ave",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "NC",
            "postal_code": "285460201",
            "country_code": "US",
            "telephone_number": "910-376-3030",
            "fax_number": "910-376-3031",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1333 S Dickinson Dr Unit 140",
            "address_purpose": "LOCATION",
            "city": "Leland",
            "state": "NC",
            "postal_code": "284516434",
            "country_code": "US",
            "telephone_number": "910-662-6600",
            "fax_number": "910-332-0246",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "510 Carolina Bay Dr Ste 110",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284032046",
            "country_code": "US",
            "telephone_number": "910-662-6000",
            "fax_number": "910-662-9703",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7420 Market St",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284119453",
            "country_code": "US",
            "telephone_number": "910-662-6200",
            "fax_number": "910-686-1606",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5145 S College Rd",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284122207",
            "country_code": "US",
            "telephone_number": "910-662-6000",
            "fax_number": "910-792-0160",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NOVANT HEALTH MEDICAL GROUP COASTAL REGION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-23",
        "last_updated": "2024-10-22",
        "certification_date": "2024-10-19",
        "status": "A",
        "authorized_official_last_name": "WALTON",
        "authorized_official_first_name": "LEEA",
        "authorized_official_middle_name": "JEANINE",
        "authorized_official_title_or_position": "ENROLLMENT MANAGER",
        "authorized_official_telephone_number": "336-515-7085"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New Hanover Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Novant Health New Hanover Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.