NPIMap

Organization Active NPI

Novant Medical Group, Inc.

Doing business as Novant Health Northlake Dermatology

  • Dermatology Physician
  • Charlotte, NC
National Provider Identifier
1952933301
Registry record updated Feb 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
NOVANT MEDICAL GROUP, INC.
Doing business as
Novant Health Northlake Dermatology
Practice address
6324 Fairview Rd # 200
Charlotte, NC 28210-3271
Phone
(704) 316-5070
Fax
(704) 316-5075
NPI assigned
Feb 4, 2020
Last updated
Feb 4, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2020

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

Authorized official

Name
Shala Davis
Title
Enrollment Manager
Phone
(704) 316-7845

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

6324 Fairview Rd # 200
Charlotte, NC 28210-3271

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 316-5070

Other names 1

  • Novant Health Northlake Dermatology Doing business as

Medicare participation

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

Enrollment records 1

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 Specialty503 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

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1580774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580774400000",
    "number": "1952933301",
    "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": "704-316-5070",
            "fax_number": "704-316-5075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6324 FAIRVIEW RD # 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282103271",
            "telephone_number": "704-316-5070",
            "fax_number": "704-316-5075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-04",
        "last_updated": "2020-02-04",
        "certification_date": "2020-02-04",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "SHALA",
        "authorized_official_title_or_position": "ENROLLMENT MANAGER",
        "authorized_official_telephone_number": "704-316-7845"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Northlake Dermatology",
            "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 Feb 4, 2020; 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.