NPIMap

Organization Active NPI

Novant Health Medical Group, LLC

Doing business as Novant Health Mintview OB/GYN

  • Obstetrics & Gynecology Physician
  • Charlotte, NC
National Provider Identifier
1710228077
Registry record updated Jun 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
NOVANT HEALTH MEDICAL GROUP, LLC
Doing business as
Novant Health Mintview OB/GYN
Practice address
15830 Ballantyne Medical PL Ste 275
Charlotte, NC 28277-4791
Phone
(704) 542-0744
Fax
(704) 543-7713
NPI assigned
Mar 12, 2013
Last updated
Jun 20, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2024

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

15830 Ballantyne Medical PL Ste 275
Charlotte, NC 28277-4791

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 542-0744

Other practice location 1

10905 Providence Road
Ste 260
Charlotte, NC 28277-1538
Phone (704) 542-0744

Other names 1

  • Novant Health Mintview 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 Care504 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

14215 Ballantyne Corporate Pl
Ste 1
Charlotte, NC 28277

1918 Randolph Rd
Ste 300
Charlotte, NC 28207
Phone (704) 333-0741

3129 Springbank Ln
Ste 100
Charlotte, NC 28226
Phone (704) 316-2021

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1363046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718841600000",
    "number": "1710228077",
    "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": "704-542-0744",
            "fax_number": "704-543-7713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15830 BALLANTYNE MEDICAL PL STE 275",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282774791",
            "telephone_number": "704-542-0744",
            "fax_number": "704-543-7713"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10905 Providence Road",
            "address_2": "Ste 260",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282771538",
            "country_code": "US",
            "telephone_number": "704-542-0744",
            "fax_number": "704-543-7713",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NOVANT HEALTH MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-12",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A",
        "authorized_official_last_name": "WALTON",
        "authorized_official_first_name": "LEEA",
        "authorized_official_middle_name": "JEANINE",
        "authorized_official_title_or_position": "EDI MANAGER",
        "authorized_official_telephone_number": "704-316-6081"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Mintview OB/GYN",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Novant Health Mintview 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 Jun 20, 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.