NPIMap

Organization Active NPI

Novant Health Medical Group Coastal Region, LLC

Doing business as Atlantic Urology

  • Urology Physician
  • Wilmington, NC
National Provider Identifier
1740860345
Registry record updated Oct 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
NOVANT HEALTH MEDICAL GROUP COASTAL REGION, LLC
Doing business as
Atlantic Urology
Novant Health Urology
Practice address
1814 New Hanover Medical Park Dr
Wilmington, NC 28403-5350
Phone
(910) 662-8765
NPI assigned
Apr 9, 2021
Last updated
Oct 22, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2024

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

Authorized official

Name
Leea Jeanine Walton
Title
Enrollment Manager
Phone
(336) 515-7085

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X Primary

Addresses

Primary practice location

1814 New Hanover Medical Park Dr
Wilmington, NC 28403-5350

Mailing address

PO Box 936857
Atlanta, GA 31193-6857

Other practice location 1

1333 S Dickinson Dr Unit 230
Leland, NC 28451-6434
Phone (910) 662-8765

Other practice location 2

109 Scotts Hill Medical Dr
Ste 204
Wilmington, NC 28411
Phone (910) 662-8765

Other practice location 3

3009 Medical Plaza Ln
Southport, NC 28461-5194
Phone (910) 662-8765

Other practice location 4

2000 Brabham Ave
Jacksonville, NC 28546-0201
Phone (910) 662-8765

Other names 2

  • Atlantic Urology Doing business as
  • Novant Health Urology Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210408000285 NC Part B Supplier - Clinic/Group Practice 2860809936 Receives reassigned benefits from 798 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Wilmington, NC; Wilmington, NE; Boivia, NC; Bolivia, NC; Burgaw, NC; Carolina Shores, NC; Jacksonville, NC; Leland, NC…

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D0977081Novant Health Urology - Wilmington1814 New Hanover Medical Park Drive, Wilmington, NC 28403Provider-performed microscopyFeb 20, 2027

National Provider Directory

National Provider Directory
Tax ID family
Novant Health Medical Group Coastal Region LLC56 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

2000 Brabham Ave
Ste 120
Jacksonville, NC 28546

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1617926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729555200000",
    "number": "1740860345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 936857",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311936857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1814 NEW HANOVER MEDICAL PARK DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284035350",
            "telephone_number": "910-662-8765"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1333 S Dickinson Dr Unit 230",
            "address_purpose": "LOCATION",
            "city": "Leland",
            "state": "NC",
            "postal_code": "284516434",
            "country_code": "US",
            "telephone_number": "910-662-8765",
            "fax_number": "910-254-1033",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "109 Scotts Hill Medical Dr",
            "address_2": "Ste 204",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "28411",
            "country_code": "US",
            "telephone_number": "910-662-8765",
            "fax_number": "910-362-9123",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3009 Medical Plaza Ln",
            "address_purpose": "LOCATION",
            "city": "Southport",
            "state": "NC",
            "postal_code": "284615194",
            "country_code": "US",
            "telephone_number": "910-662-8765",
            "fax_number": "910-362-9123",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2000 Brabham Ave",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "NC",
            "postal_code": "285460201",
            "country_code": "US",
            "telephone_number": "910-662-8765",
            "fax_number": "910-362-9123",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NOVANT HEALTH MEDICAL GROUP COASTAL REGION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-09",
        "last_updated": "2024-10-22",
        "certification_date": "2024-10-19",
        "status": "A",
        "authorized_official_last_name": "WALTON",
        "authorized_official_first_name": "LEEA",
        "authorized_official_middle_name": "JEANINE",
        "authorized_official_title_or_position": "ENROLLMENT MANAGER",
        "authorized_official_telephone_number": "336-515-7085"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Atlantic Urology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Novant Health Urology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.