Novant Medical Group, Inc.

Primary specialty

Pediatric Urology PhysicianTaxonomy code 2088P0231X

Legal business name

NOVANT MEDICAL GROUP, INC.

Practice address

1401 Matthews Township Pkwy
Suite 312
Matthews, NC 28105-5402

Phone

(704) 384-9530

Fax

(704) 384-9535

NPI assigned

Jun 4, 2010

Organization subpart

No

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

Authorized official

Name

Mr. Geoffrey Gardner

Title

VP of Finance

Phone

(704) 384-9094

Specialties & licenses 2

Addresses

Other names 1

• Southeast Children's Urology 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": "1275609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275609600000",
    "number": "1699095331",
    "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": "704-384-7840",
            "fax_number": "704-384-7830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 MATTHEWS TOWNSHIP PKWY",
            "address_2": "SUITE 312",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281055402",
            "telephone_number": "704-384-9530",
            "fax_number": "704-384-9535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-04",
        "last_updated": "2010-06-04",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "GEOFFREY",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "704-384-9094",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2088P0231X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology, Pediatric Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeast Children's Urology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Novant Medical Group, Inc.
• Novant Medical Group, Inc.
• Novant Medical Group, Inc.
• Novant Medical Group, Inc.
• Novant Medical Group, Inc.
• Novant Medical Group, Inc.
• Clara Lucia Nunez Romero, DDS
• Amy Marie O'Bryan, LPC
• Lindsey Danielle Oakley, PT
• Dennis Emeka Obi

• All providers in Matthews, NC
• Pediatric Urology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 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.

Verify at the official NPI Registry.