Active NPI
Novant Medical Group
Doing business as Novant Health Nutrition Solutions
- Registered Dietitian
- Clemmons, NC
National Provider Identifier
1689917783
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- Legal business name
- NOVANT MEDICAL GROUP
- Doing business as
- Novant Health Nutrition Solutions
- Practice address
- 5175 Old Clemmons School Rd
Clemmons, NC 27012-9087 - Phone
- (336) 718-6770
- Fax
- (336) 277-1889
- NPI assigned
- Mar 27, 2013
- Last updated
- Nov 29, 2013
- 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 NMG Finance
- Phone
- (704) 384-9144
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | NU | Primary | |
| Cardiovascular Disease Physician | 207RC0000X | NU |
Addresses
Primary practice location
5175 Old Clemmons School Rd
Clemmons, NC 27012-9087
Mailing address
PO Box 60447
Charlotte, NC 28260-0447
Phone (336) 718-6770
Other names 1
- Novant Health Nutrition Solutions
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 DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1364342400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1385683200000",
"number": "1689917783",
"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": "336-718-6770",
"fax_number": "336-277-1889"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5175 OLD CLEMMONS SCHOOL RD",
"city": "CLEMMONS",
"state": "NC",
"postal_code": "270129087",
"telephone_number": "336-718-6770",
"fax_number": "336-277-1889"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NOVANT MEDICAL GROUP",
"organizational_subpart": "NO",
"enumeration_date": "2013-03-27",
"last_updated": "2013-11-29",
"status": "A",
"authorized_official_last_name": "GARDNER",
"authorized_official_first_name": "GEOFFREY",
"authorized_official_middle_name": "K",
"authorized_official_title_or_position": "VP OF NMG FINANCE",
"authorized_official_telephone_number": "704-384-9144"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Novant Health Nutrition Solutions",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Clemmons, NC
- Novant Health Medical Group, LLC (Novant Health Adult Primary Care Tanglewood)
- Novant Health Medical Group, LLC (Novant Health Extended Care)
- Novant Health Medical Group, LLC (Novant Health Primary Care)
- Novant Health Medical Group, LLC (Novant Health Surgical Wellness)
- Novant Health Thomasville Medical Center, LLC (Novant Health Infusion)
- Novant Medical Group Inc (Novant Health Nutrition Solutions)
- Novant Medical Group Inc (Novant Health Colon and Rectal Clinic)
- Novant Medical Group Inc (Novant Health Triad Surgical Associates)
- Novant Medical Group, Inc (Novant Health Orthopedics & Sports Medicine)
- Novant Medical Group, Inc. (Novant Health Transitional Care & Infusion)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2013; 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.