Novant Medical Group Inc

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

NOVANT MEDICAL GROUP INC

Doing business as

Novant Health Lakeside Physical Therapy & Sports Medicine

Practice address

14330 Oakhill Park Lane
Suite 115
Huntersville, NC 28078-3479

Phone

(704) 316-1265

Fax

(704) 316-1266

NPI assigned

Mar 8, 2013

Last updated

Mar 11, 2015By 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

Mr. Geoffrey Keith Gardner

Title

VP Finance

Phone

(704) 384-7603

Specialties & licenses 1

Addresses

Other names 1

• Novant Health Lakeside Physical Therapy & Sports Medicine Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Practitioners 6

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.

• Robert Anthony Barnabei, MD

  • Family Medicine Physician
  • Charlotte, NC
  • NPI 1396708285
  NPD
• Noellee Tashina Clarke, MD

  • Obstetrics & Gynecology Physician
  • Charlotte, NC
  • NPI 1447389663
  NPD
• Zoe M Comer, NP

  • Nurse Practitioner
  • Winston Salem, NC
  • NPI 1871722538
  NPD
• Ajike Ogunsulire Etumadu

  • Internal Medicine Physician
  • Charlotte, NC
  • NPI 1457316168
  NPD
• Steven Lee Gilchrist, MD

  • Family Medicine Physician
  • Charlotte, NC
  • NPI 1356549851
  NPD
• Beth Ann Jayne, MD

  • Internal Medicine Physician
  • Watertown, NY
  • NPI 1871607184
  NPD

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

{
    "created_epoch": "1362700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426032000000",
    "number": "1710228283",
    "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": "704-316-1265",
            "fax_number": "704-316-1266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14330 OAKHILL PARK LANE",
            "address_2": "SUITE 115",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280783479",
            "telephone_number": "704-316-1265",
            "fax_number": "704-316-1266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-08",
        "last_updated": "2015-03-11",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "GEOFFREY",
        "authorized_official_middle_name": "KEITH",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "704-384-7603",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Lakeside Physical Therapy & Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Novant Health Prep II LLC (Surgical Specialists of Charlotte, a Novant Health network provider - Huntersville)
• Novant Health Sports & Performance Medicine
• Novant Medical Group Inc (Novant Health Psychiatric Associates)
• Novant Medical Group Inc (Novant Health Lakeside Physical Therapy & Sports Medicine)
• Novant Medical Group Inc (Novant Health Huntersville Obstetrics and Gynecology)
• Novant Medical Group, Inc (Novant Health Northlake Neurology)
• Novant Medical Group, Inc (Novant Health Carolina Surgical)
• Novant Medical Group, Inc (Novant Health Rehabilitation Center)
• Novant Medical Group, Inc. (Novant Health Family Medicine Residency Clinic)
• Novant Medical Group, Inc. (Mid Carolina Cardiology)

• Physical Therapist in Huntersville, NC
• Providers in Huntersville, NC by specialty
• Physical Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2015; 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.