Novant Medical Group Inc

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

Legal business name

NOVANT MEDICAL GROUP INC

Practice address

205 Sandalwood Ave
Suite a
Louisburg, NC 27549-2679

Phone

(919) 496-4250

Fax

(919) 496-1515

NPI assigned

Jul 14, 2008

Organization subpart

No

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

Authorized official

Name

Geoffrey Gardner

Title

VP of Finance

Phone

(919) 496-4250

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Novant Health Perry Medders Medical Group 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": "1215993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1385683200000",
    "number": "1700040375",
    "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": "919-496-4250",
            "fax_number": "919-496-1515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 SANDALWOOD AVE",
            "address_2": "SUITE A",
            "city": "LOUISBURG",
            "state": "NC",
            "postal_code": "275492679",
            "telephone_number": "919-496-4250",
            "fax_number": "919-496-1515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-14",
        "last_updated": "2013-11-29",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "GEOFFREY",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "919-496-4250"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5911436",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CC5118",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Perry Medders Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brittany Hicks Newell, FNP
• Nextlevel Screening & Identification
• North Carolina CVS Pharmacy LLC
• North Carolina Em-I Medical Services PC
• North Carolina Surgical Associates, PLLC
• Novant Medical Group Inc
• Novant Medical Group Inc
• Novant Medical Group, Inc
• Novant Medical Group, Inc.
• Michael Andre Nustar

• Pulmonary Disease Physician in Louisburg, NC
• Providers in Louisburg, NC by specialty
• Pulmonary Disease Physician in North Carolina

• 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.

Verify at the official NPI Registry.