NPIMap

Organization Active NPI

Novant Health Medical Group, LLC

  • Obstetrics & Gynecology Physician
  • Charlotte, NC
National Provider Identifier
1689680332
Registry record updated Aug 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
NOVANT HEALTH MEDICAL GROUP, LLC
Practice address
1901 E 5TH St
Charlotte, NC 28204-2429
Phone
(980) 367-4363
Fax
(704) 384-1644
NPI assigned
Aug 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2024

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

Authorized official

Name
Leea Jeanine Walton
Title
RCS Manager
Phone
(704) 316-6081

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

1901 E 5TH St
Charlotte, NC 28204-2429

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (980) 367-4363

Other practice location 1

200 Hawthorne Ln
Charlotte, NC 28204-2515
Phone (704) 384-0560

Other practice location 2

6331 Carmel Rd Ste 102
Charlotte, NC 28226-8286
Phone (980) 367-4363

Other identifiers 4

IdentifierTypeStateIssuer
018F6OtherNCBCBS NC
5904172MedicaidNC
CC5118OtherNCRAILROAD MEDICARE
NPB180MedicaidSC

Other names 2

  • Novant Health Inpatient Care Specialists Doing business as
  • Novant Health Inpatient Care Specialists OB/GYN 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 Care503 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

Locations

10030 Gilead Rd
Huntersville, NC 28078
Phone (704) 316-4000

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724198400000",
    "number": "1689680332",
    "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": "980-367-4363",
            "fax_number": "704-316-2558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 E 5TH ST",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282042429",
            "telephone_number": "980-367-4363",
            "fax_number": "704-384-1644"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Hawthorne Ln",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282042515",
            "country_code": "US",
            "telephone_number": "704-384-0560",
            "fax_number": "704-384-0561",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6331 Carmel Rd Ste 102",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282268286",
            "country_code": "US",
            "telephone_number": "980-367-4363",
            "fax_number": "704-316-2558",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NOVANT HEALTH MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-01",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-21",
        "status": "A",
        "authorized_official_last_name": "WALTON",
        "authorized_official_first_name": "LEEA",
        "authorized_official_middle_name": "JEANINE",
        "authorized_official_title_or_position": "RCS MANAGER",
        "authorized_official_telephone_number": "704-316-6081"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NC",
            "identifier": "018F6",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5904172",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CC5118",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NPB180",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Inpatient Care Specialists",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Novant Health Inpatient Care Specialists",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Novant Health Inpatient Care Specialists OB/GYN",
            "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 21, 2024; 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.