Novant Health Medical Group, LLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

NOVANT HEALTH MEDICAL GROUP, LLC

Doing business as

Novant Health General Surgery

Practice address

131 Medical Park Rd Ste 305
Mooresville, NC 28117-8525

Phone

(704) 663-0006

Fax

(704) 663-5224

NPI assigned

Apr 24, 2024

Last updated

May 2, 2024By 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

Leea Jeanine Walton

Title

Med Cred Coord Lead

Phone

(704) 316-6081

Specialties & licenses 1

Addresses

Other names 1

• Novant Health General Surgery Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

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

{
    "created_epoch": "1713916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714608000000",
    "number": "1881440550",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 MEDICAL PARK RD STE 305",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178525",
            "telephone_number": "704-663-0006",
            "fax_number": "704-663-5224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT HEALTH MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-24",
        "last_updated": "2024-05-02",
        "certification_date": "2024-05-02",
        "status": "A",
        "authorized_official_last_name": "WALTON",
        "authorized_official_first_name": "LEEA",
        "authorized_official_middle_name": "JEANINE",
        "authorized_official_title_or_position": "MED CRED COORD LEAD",
        "authorized_official_telephone_number": "704-316-6081"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health General Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Novant Health Medical Group, LLC (Novant Health General Surgery & Bariatrics)
• Novant Health Medical Group, LLC (Novant Health Internal Medicine Gateway)
• Novant Health Medical Group, LLC (Novant Health Family Medicine Tall Oaks)
• Novant Health Medical Group, LLC (Lake Norman Medical Group, Family Medicine Tall Oaks)
• Novant Health Medical Group, LLC (Novant Health Harborside Pediatrics)
• Novant Medical Group Inc (Novant Health Nurse Midwifery Associates Langtree)
• Novant Medical Group Inc (Sherrill-Jackson Orthopedic Center)
• Novant Medical Group Inc (Lake Norman Neonatology Associates)
• Novant Medical Group Inc (Novant Health Pulmonary & Critical Care)
• Novant Medical Group Inc (Primary Care Associates)

• Surgery Physician in Mooresville, NC
• Providers in Mooresville, NC by specialty
• Surgery Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 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.