NPIMap

Organization Active NPI

NMG Southpark Services, LLC

Doing business as Novant Nurse Anesthesia Professional Services

  • Certified Registered Nurse Anesthetist
  • Charlotte, NC
National Provider Identifier
1952690109
Registry record updated Nov 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
NMG SOUTHPARK SERVICES, LLC
Doing business as
Novant Nurse Anesthesia Professional Services
Practice address
6035 Fairview Rd
Charlotte, NC 28210-3256
Phone
(704) 295-3000
Fax
(952) 442-3620
NPI assigned
Mar 28, 2011
Last updated
Nov 26, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2013

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

Authorized official

Name
Geoff Gardner
Title
VP of Finance
Phone
(336) 718-2078

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X NU Primary

Addresses

Primary practice location

6035 Fairview Rd
Charlotte, NC 28210-3256

Mailing address

PO Box 602579
Charlotte, NC 28260-2579
Phone (952) 442-9770

Other names 1

  • NOVANT NURSE ANESTHESIA PROFESSIONAL SERVICES Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110808000705 NC Part B Supplier - Clinic/Group Practice 6901075977 Receives reassigned benefits from 112 practitioners
Practice locations: Matthews, NC; Supply, NC; Charlotte, NC

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

710 Park Center Dr
Ste 100
Matthews, NC 28105
Phone (704) 815-7880

Practitioners & affiliated clinicians

Practitioners 121

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 121

NPI Registry JSON

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

{
    "created_epoch": "1301270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1385424000000",
    "number": "1952690109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 602579",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282602579",
            "telephone_number": "952-442-9770",
            "fax_number": "952-442-3620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6035 FAIRVIEW RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282103256",
            "telephone_number": "704-295-3000",
            "fax_number": "952-442-3620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NMG SOUTHPARK SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-28",
        "last_updated": "2013-11-26",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "GEOFF",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "336-718-2078"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NOVANT NURSE ANESTHESIA PROFESSIONAL SERVICES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2013; 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.