Active NPI
Novant Medical Group, Inc.
- Family Medicine Physician
- Monroe, NC
National Provider Identifier
1639170244
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- NOVANT MEDICAL GROUP, INC.
- Practice address
- 602 S Sutherland Ave
Monroe, NC 28112-5063 - Phone
- (704) 384-4820
- Fax
- (704) 384-8425
- NPI assigned
- Aug 4, 2005
- 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
- Dinesh S Pai
- Title
- VP of Operations
- Phone
- (704) 384-9104
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
602 S Sutherland Ave
Monroe, NC 28112-5063
Mailing address
PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 384-7840
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5901677 | Medicaid | NC | |
| 017F7 | Other | NC | BCBS |
Other names 1
- Rocky River Family Physicians
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040204001028 | NC | Part B Supplier - Clinic/Group Practice | 1153234893 |
Receives reassigned benefits from 648 practitioners This NPI is an additional NPI on the enrollment Practice locations: Denver, NC; High Point, NC; Huntersville, NC; Indian Trail, NC; Matthews, NC; Monroe, NC; Mooresville, NC; Salisbury, NC… |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123113600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1212969600000",
"number": "1639170244",
"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": "704-384-7840",
"fax_number": "704-384-7830"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "602 S SUTHERLAND AVE",
"city": "MONROE",
"state": "NC",
"postal_code": "281125063",
"telephone_number": "704-384-4820",
"fax_number": "704-384-8425"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NOVANT MEDICAL GROUP, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2005-08-04",
"last_updated": "2008-06-09",
"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": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5901677",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "017F7",
"state": "NC"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Rocky River Family Physicians",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Monroe, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2008; 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.