NPIMap

Organization Active NPI

Novant Health Medical Group Coastal Region, LLC

  • Surgery Physician
  • Wilmington, NC
National Provider Identifier
1962082479
Registry record updated Dec 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
NOVANT HEALTH MEDICAL GROUP COASTAL REGION, LLC
Practice address
2221 S 17TH St
Wilmington, NC 28401-7542
Phone
(910) 662-7720
Fax
(910) 815-0840
NPI assigned
Apr 9, 2021
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Shala Davis
Title
RCS Manager
Phone
(704) 303-7517

Corporate family (same tax ID) 14

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

View all 14

Practitioners 5

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210408000285 NC Part B Supplier - Clinic/Group Practice 2860809936 Receives reassigned benefits from 798 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Wilmington, NC; Wilmington, NE; Boivia, NC; Bolivia, NC; Burgaw, NC; Carolina Shores, NC; Jacksonville, NC; Leland, NC…

National Provider Directory

National Provider Directory
Tax ID family
Novant Health Medical Group Coastal Region LLC (56 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

2221 S 17TH St
Wilmington, NC 28401-7542

Mailing address

PO Box 936857
Atlanta, GA 31193-6857

Other practice location 1

109 Scotts Hill Medical Dr.
Ste 204
Wilmington, NC 28411
Phone (910) 662-7720

Other practice location 2

2000 Brabham Ave
Jacksonville, NC 28546-0201
Phone (910) 662-7720

Other names 2

NPPES NPI Registry
  • NHRMC Physician Specialists - General Surgery Specialists - Colon & Re Doing business as
  • Novant Health General Surgery (Colon & Rectal) 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 Dec 2, 2024.

{
    "created_epoch": "1617926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733097600000",
    "number": "1962082479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 936857",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311936857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2221 S 17TH ST",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017542",
            "telephone_number": "910-662-7720",
            "fax_number": "910-815-0840"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "109 Scotts Hill Medical Dr.",
            "address_2": "Ste 204",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "28411",
            "country_code": "US",
            "telephone_number": "910-662-7720",
            "fax_number": "910-815-0840",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2000 Brabham Ave",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "NC",
            "postal_code": "285460201",
            "country_code": "US",
            "telephone_number": "910-662-7720",
            "fax_number": "910-815-0840",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NOVANT HEALTH MEDICAL GROUP COASTAL REGION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-09",
        "last_updated": "2024-12-02",
        "certification_date": "2024-11-27",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "SHALA",
        "authorized_official_title_or_position": "RCS MANAGER",
        "authorized_official_telephone_number": "704-303-7517"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NHRMC Physician Specialists - General Surgery Specialists - Colon & Re",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Novant Health General Surgery (Colon & Rectal)",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 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.