NPIMap

Organization Active NPI

Novant Health Medical Group, LLC

Doing business as Novant Diabetes & Nutrition

  • Internal Medicine Physician
  • Winston Salem, NC
National Provider Identifier
1962048512
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
NOVANT HEALTH MEDICAL GROUP, LLC
Doing business as
Novant Diabetes & Nutrition
Practice address
1400 Westgate Ctr Dr Ste 110
Winston Salem, NC 27103-3104
Phone
(980) 302-9307
Fax
(704) 316-9859
NPI assigned
Nov 19, 2019
Last updated
Jul 15, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
NOVANT HEALTH MEDICAL GROUP, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X
Internal Medicine Physician 207R00000X Primary

Addresses

Primary practice location

1400 Westgate Ctr Dr Ste 110
Winston Salem, NC 27103-3104

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Other names 1

  • Novant Diabetes & Nutrition 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 Inpt Care504 organizations share this tax ID, including this one
Part of
Presbyterian Inpt Care

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

NPI Registry JSON

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

{
    "created_epoch": "1574121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721001600000",
    "number": "1962048512",
    "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": "1400 WESTGATE CTR DR STE 110",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271033104",
            "telephone_number": "980-302-9307",
            "fax_number": "704-316-9859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT HEALTH MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NOVANT HEALTH MEDICAL GROUP, LLC",
        "enumeration_date": "2019-11-19",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "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": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Diabetes & Nutrition",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Novant Diabetes & Nutrition",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 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.