Novant Health Medical Group, LLC
Organization Active NPI Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician · Charlotte, NC
NPI 1891764320 · NPPES record last updated Jun 20, 2024
Key facts
- NPI
- 1891764320
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X
- Legal business name
- NOVANT HEALTH MEDICAL GROUP, LLC
- Practice address
- 125 Queens Rd Ste 250
Charlotte, NC 28204-3215 - Phone
- (704) 316-5100
- Fax
- (704) 316-5101
- NPI assigned
- Mar 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Leea Jeanine Walton
- Title
- RCS Manager
- Phone
- (704) 316-6081
Other NPIs on the same Medicare enrollment 19
Other NPIs with the same Medicare PAC ID 13
Practitioners 2,445
-
Linda Agyapong, M.D.
-
Asaad Elsayed Ahmed, M.D.
-
Amy Lowery Alexanian, M.D.
-
Aram Alexanian, M.D.
-
Suima Aryal, MD
-
Candace Anjanee Boone, FNP-BC
-
Carrie E Bush, MSN, FNP
-
Brian Kristian Cain, M.D.
-
Lakshmi Chalavadi, M.D.
-
Tanya Lisette De la Cruz, PA-C
-
James Desimone, FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
| O20060828000304 | NC | Part B Supplier - Clinic/Group Practice | 1153234893 |
Receives reassigned benefits from 106 practitioners 19 other NPIs on this enrollment Practice locations: Salisbury, NC; Matthews, NC; Locust, NC; Durham, NC; Concord, NC; Charlotte, NC |
National Provider Directory
Locations
301 Hawthorne Ln
Ste 200
Charlotte, NC 28204
Phone (704) 316-5100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular Surgery Physician |
2086S0129X | |||
| Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician |
208G00000X | Yes |
Addresses
Primary practice location
125 Queens Rd Ste 250
Charlotte, NC 28204-3215
Mailing address
PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 316-5100
Other practice location 1
301 Hawthorne Ln
Suite 200
Charlotte, NC 28204-2467
Phone (704) 316-5100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NPA523 | Medicaid | SC | |
| 89015GA | Medicaid | NC | |
| 015GA | Other | NC | BCBS NC |
Other names
- Novant Health Heart and Vascular Institute
Other providers in Charlotte, NC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC
All providers in Charlotte, NC · Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.