NPIMap

Organization Active NPI

Novant Medical Group. Inc.

Doing business as Novant Health Diabetes & Nutrition

  • Internal Medicine Physician
  • Thomasville, NC
National Provider Identifier
1649816273
Registry record updated Aug 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
NOVANT MEDICAL GROUP. INC.
Doing business as
Novant Health Diabetes & Nutrition
Practice address
903 Randolph St
Thomasville, NC 27360-5898
Phone
(980) 302-9307
Fax
(704) 316-9859
NPI assigned
Nov 19, 2019
Last updated
Aug 17, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
NOVANT MEDICAL GROUP, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 17, 2021

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

Authorized official

Name
Shala Davis
Title
Managed Care Manager
Phone
(704) 303-7517

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X
Internal Medicine Physician 207R00000X Primary

Addresses

Primary practice location

903 Randolph St
Thomasville, NC 27360-5898

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Other names 1

  • Novant Health Diabetes & Nutrition 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 Specialty503 organizations share this tax ID, including this one
Part of
Presbyterian Specialty

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 1

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": "1574121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629158400000",
    "number": "1649816273",
    "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": "903 RANDOLPH ST",
            "city": "THOMASVILLE",
            "state": "NC",
            "postal_code": "273605898",
            "telephone_number": "980-302-9307",
            "fax_number": "704-316-9859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT MEDICAL GROUP. INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NOVANT MEDICAL GROUP, INC.",
        "enumeration_date": "2019-11-19",
        "last_updated": "2021-08-17",
        "certification_date": "2021-08-17",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "SHALA",
        "authorized_official_title_or_position": "MANAGED CARE MANAGER",
        "authorized_official_telephone_number": "704-303-7517"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Diabetes & Nutrition",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Novant Health Diabetes & Nutrition",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Thomasville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2021; 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.