Novant Medical Group Inc

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

Legal business name

NOVANT MEDICAL GROUP INC

Practice address

205 Sandalwood Ave
Suite a
Louisburg, NC 27549-2679

Phone

(919) 497-3526

Fax

(919) 497-3539

NPI assigned

Nov 5, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Geoffery K Gardner

Title

VP Finance

Phone

(919) 497-3526

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Novant Health Catalyst Family & Sports Medicine Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

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

{
    "created_epoch": "1352073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377648000000",
    "number": "1972857449",
    "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": "919-497-3526",
            "fax_number": "919-497-3539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 SANDALWOOD AVE",
            "address_2": "SUITE A",
            "city": "LOUISBURG",
            "state": "NC",
            "postal_code": "275492679",
            "telephone_number": "919-497-3526",
            "fax_number": "919-497-3539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-05",
        "last_updated": "2013-08-28",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "GEOFFERY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "919-497-3526",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5921899",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Catalyst Family & Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• North Carolina CVS Pharmacy LLC
• North Carolina Em-I Medical Services PC
• North Carolina Surgical Associates, PLLC
• Novant Medical Group Inc
• Novant Medical Group Inc
• Novant Medical Group, Inc
• Novant Medical Group, Inc.
• Michael Andre Nustar
• Joyce Ekwutosi Ogbu
• Shiffon P Oliver, CRC, LCMHCA

• Sports Medicine (Family Medicine) Physician in Louisburg, NC
• Providers in Louisburg, NC by specialty
• Sports Medicine (Family Medicine) Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 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.