NPIMap

Organization Active NPI

Novant Health Medical Group, LLC

  • Surgery Physician
  • Matthews, NC
National Provider Identifier
1932631850
Registry record updated Jun 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
NOVANT HEALTH MEDICAL GROUP, LLC
Practice address
1450 Matthews Township Pkwy
Suite 355
Matthews, NC 28105-2387
Phone
(704) 333-1259
Fax
(704) 333-0371
NPI assigned
Mar 30, 2017
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Leea Jeanine Walton
Title
RCS Manager
Phone
(704) 316-6081

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

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

Medicare enrollment records 1

Medicare enrollment files
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 Care (503 organizations share this tax ID)

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X Primary

Addresses

NPPES NPI Registry

Primary practice location

1450 Matthews Township Pkwy
Suite 355
Matthews, NC 28105-2387

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 333-1259

Other names 1

NPPES NPI Registry
  • Novant Health Charlotte Colon and Rectal Surgery Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 20, 2024.

{
    "created_epoch": "1490832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718841600000",
    "number": "1932631850",
    "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": "704-333-1259",
            "fax_number": "704-333-0371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 MATTHEWS TOWNSHIP PKWY",
            "address_2": "SUITE 355",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281052387",
            "telephone_number": "704-333-1259",
            "fax_number": "704-333-0371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT HEALTH MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-30",
        "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": "RCS MANAGER",
        "authorized_official_telephone_number": "704-316-6081"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Charlotte Colon and Rectal Surgery",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Novant Health Charlotte Colon and Rectal Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Matthews, 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.