NPIMap

Organization Active NPI

Novant Medical Group Inc

  • Psychiatry Physician
  • Cornelius, NC
National Provider Identifier
1972168508
Registry record updated Oct 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
NOVANT MEDICAL GROUP INC
Practice address
19485 Old Jetton Rd Ste 270
Cornelius, NC 28031-6592
Phone
(704) 384-7680
NPI assigned
May 9, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2019

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
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

19485 Old Jetton Rd Ste 270
Cornelius, NC 28031-6592

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Other names 1

  • Novant Health Addiction Recovery & Counseling 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 Care503 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.

NPI Registry JSON

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

{
    "created_epoch": "1557360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571270400000",
    "number": "1972168508",
    "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": "19485 OLD JETTON RD STE 270",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280316592",
            "telephone_number": "704-384-7680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-09",
        "last_updated": "2019-10-17",
        "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": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Addiction Recovery & Counseling",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cornelius, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2019; 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.