Active NPI
Novant Medical Group Inc
- Plastic Surgery Physician
- Charlotte, NC
National Provider Identifier
1669788758
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic Surgery Physician
- Legal business name
- NOVANT MEDICAL GROUP INC
- Practice address
- 5933 Blakeney Park Dr
Suite 101
Charlotte, NC 28277-5713 - Phone
- (704) 444-5800
- Fax
- (704) 444-5819
- NPI assigned
- Aug 26, 2010
- 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
- Geoffrey K. Gardner
- Title
- VP of Finance
- Phone
- (704) 384-9094
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery Physician | 208200000X | Primary |
Addresses
Primary practice location
5933 Blakeney Park Dr
Suite 101
Charlotte, NC 28277-5713
Mailing address
PO Box 602362
Charlotte, NC 28260-2362
Phone (704) 444-5800
Other names 1
- Calabretta Cosmetic Surgery Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 DirectoryLocations
5933 Blakeney Park Dr
Ste 101
Charlotte, NC 28277
Phone (704) 316-2061
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1282780800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1282780800000",
"number": "1669788758",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 602362",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282602362",
"telephone_number": "704-444-5800",
"fax_number": "704-444-5819"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5933 BLAKENEY PARK DR",
"address_2": "SUITE 101",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282775713",
"telephone_number": "704-444-5800",
"fax_number": "704-444-5819"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NOVANT MEDICAL GROUP INC",
"organizational_subpart": "NO",
"enumeration_date": "2010-08-26",
"last_updated": "2010-08-26",
"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": "704-384-9094"
},
"taxonomies": [
{
"code": "208200000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Plastic Surgery",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Calabretta Cosmetic Surgery Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2010; 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.