NPIMap

Organization Active NPI

Novant Medical Group, Inc.

Doing business as Novant Health Miller Street Family Medicine

  • Family Medicine Physician
  • Winston Salem, NC
National Provider Identifier
1639620107
Registry record updated Aug 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
NOVANT MEDICAL GROUP, INC.
Doing business as
Novant Health Miller Street Family Medicine
Practice address
50 Miller St
Ste G
Winston Salem, NC 27104
Phone
(704) 384-7605
NPI assigned
Oct 20, 2016
Last updated
Aug 7, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2018

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

Authorized official

Name
Geoffrey K Gardner
Title
VP of Finance
Phone
(704) 384-7605

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X NC Primary

Addresses

Primary practice location

50 Miller St
Ste G
Winston Salem, NC 27104

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 384-7840

Other practice location 1

50 Miller St
Ste G
Winston Salem, NC 27104-4206
Phone (704) 384-7605

Other practice location 2

50 Miller St
Ste G
Winston Salem, NC 27104-4206
Phone (704) 384-7605

Other names 1

  • Novant Health Miller Street Family Medicine Doing business as

Medicare participation

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

Enrollment records 1

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 Care504 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Practitioners & affiliated clinicians

Practitioners 6

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": "1476921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533600000000",
    "number": "1639620107",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 MILLER ST",
            "address_2": "STE G",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "27104",
            "telephone_number": "704-384-7605"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "50 Miller St",
            "address_2": "STE G",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271044206",
            "country_code": "US",
            "telephone_number": "704-384-7605",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "50 Miller St",
            "address_2": "STE G",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271044206",
            "country_code": "US",
            "telephone_number": "704-384-7605",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NOVANT MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-20",
        "last_updated": "2018-08-07",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "GEOFFREY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "704-384-7605"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Miller Street Family Medicine",
            "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 Aug 7, 2018; 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.