Novant Medical Group, Inc

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

2007-01837 Issued in NC

Legal business name

NOVANT MEDICAL GROUP, INC

Doing business as

Mid Carolina Cardiology

Practice address

8310 University Exec Park Dr
Suite 550
Charlotte, NC 28262-3383

Phone

(704) 226-0500

Fax

(704) 226-0599

NPI assigned

Oct 12, 2012

Last updated

Oct 12, 2012By the provider in NPPES

Organization subpart

No

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) 384-7606

Specialties & licenses 1

Addresses

Other names 1

• Mid Carolina Cardiology Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

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

{
    "created_epoch": "1350000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350000000000",
    "number": "1689926792",
    "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": "704-226-0500",
            "fax_number": "704-226-0599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8310 UNIVERSITY EXEC PARK DR",
            "address_2": "SUITE 550",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282623383",
            "telephone_number": "704-226-0500",
            "fax_number": "704-226-0599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-12",
        "last_updated": "2012-10-12",
        "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": "704-384-7606"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NC",
            "license": "2007-01837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mid Carolina Cardiology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Cardiovascular Disease Physician in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Cardiovascular Disease Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2012; 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.