NPIMap

Organization Active NPI

Novant Health Medical Group, LLC

Doing business as Novant Health Senior Living Health Services

  • Family Medicine Physician
  • Winston Salem, NC
National Provider Identifier
1982110342
Registry record updated Jul 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
NOVANT HEALTH MEDICAL GROUP, LLC
Doing business as
Novant Health Senior Living Health Services
Practice address
2085 Frontis Plaza Blvd
Winston Salem, NC 27103-5614
Phone
(336) 481-8655
Fax
(336) 277-9165
NPI assigned
Dec 21, 2017
Last updated
Jul 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

2085 Frontis Plaza Blvd
Winston Salem, NC 27103-5614

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Other practice location 1

2000 Frontis Plaza Blvd Ste 200
Winston Salem, NC 27103-5616
Phone (336) 481-8655

Other practice location 2

3545 Whitehall Park Dr Ste 300
Charlotte, NC 28273-4179
Phone (704) 316-6187

Other practice location 3

1236 Guilford College Rd Ste 117
Jamestown, NC 27282
Phone (336) 856-0801

Other names 1

  • Novant Health Senior Living Health Services 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

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1513814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720483200000",
    "number": "1982110342",
    "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": "2085 FRONTIS PLAZA BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271035614",
            "telephone_number": "336-481-8655",
            "fax_number": "336-277-9165"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2000 Frontis Plaza Blvd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271035616",
            "country_code": "US",
            "telephone_number": "336-481-8655",
            "fax_number": "336-277-9165",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3545 Whitehall Park Dr Ste 300",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282734179",
            "country_code": "US",
            "telephone_number": "704-316-6187",
            "fax_number": "704-316-6217",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1236 Guilford College Rd Ste 117",
            "address_purpose": "LOCATION",
            "city": "Jamestown",
            "state": "NC",
            "postal_code": "27282",
            "country_code": "US",
            "telephone_number": "336-856-0801",
            "fax_number": "336-856-2804",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NOVANT HEALTH MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-21",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "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": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Senior Living Health Services",
            "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 9, 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.