NPIMap

Organization Active NPI

Novant Health Medical Group Coastal Region, LLC

  • Cardiovascular Disease Physician
  • Wilmington, NC
National Provider Identifier
1649865791
Registry record updated Jul 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
NOVANT HEALTH MEDICAL GROUP COASTAL REGION, LLC
Practice address
1415 Physicians Dr
Wilmington, NC 28401-7338
Phone
(910) 662-9700
NPI assigned
Mar 1, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2021

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X Primary

Addresses

Primary practice location

1415 Physicians Dr
Wilmington, NC 28401-7338

Mailing address

PO Box 936857
Atlanta, GA 31193-6857

Other names 1

  • NHMGCR Cape Fear Heart 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
Practice locations: Wilmington, NC; Wilmington, NE; Boivia, NC; Bolivia, NC; Burgaw, NC; Carolina Shores, NC; Jacksonville, NC; Leland, NC…

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

584 Hospital Dr NE
Unit E
Bolivia, NC 28422
Phone (910) 754-5453

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

Practitioners & affiliated clinicians

Practitioners 820

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 820

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626652800000",
    "number": "1649865791",
    "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": "1415 PHYSICIANS DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017338",
            "telephone_number": "910-662-9700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT HEALTH MEDICAL GROUP COASTAL REGION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-01",
        "last_updated": "2021-07-19",
        "certification_date": "2021-07-19",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "SHALA",
        "authorized_official_title_or_position": "RCS MANAGER",
        "authorized_official_telephone_number": "704-303-7517"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NHMGCR Cape Fear Heart",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NHMGCR Cape Fear Heart",
            "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 Jul 19, 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.