Novant Health Medical Group, LLC

Primary specialty

Urology PhysicianTaxonomy code 208800000X

Legal business name

NOVANT HEALTH MEDICAL GROUP, LLC

Practice address

584 Hospital Dr NE
Suite D
Bolivia, NC 28422-9047

Phone

(910) 721-4150

Fax

(910) 721-4159

NPI assigned

Mar 19, 2012

Organization subpart

No

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

Addresses

Other names 1

• Novant Health Urology Partners Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sarah Hayden Delabastide, PA-C

  • Physician Assistant
  • Bolivia, NC
  • NPI 1629499439
  NPD
• Elizabeth Warren Desandre, NP

  • Nurse Practitioner
  • Bolivia, NC
  • NPI 1821678368
  NPD
• Nancy Susan Desillier, RN

  • Nurse Practitioner
  • Bolivia, NC
  • NPI 1104524271
  NPD
• Shawn Howard Fleming, MD

  • Vascular Surgery Physician
  • Winston Salem, NC
  • NPI 1902089345
  NPD
• Brian Scott Maieli, PA-C, ATC, CSCS

  • Physician Assistant
  • Winston Salem, NC
  • NPI 1700052297
  NPD
• Steven Eric Robbins, MD

  • Urology Physician
  • Bolivia, NC
  • NPI 1710919006
  NPD
• John Joseph Smith III, MD

  • Urology Physician
  • Winston Salem, NC
  • NPI 1477540466
  NPD
• Lori Ann Hanrahan, FNP

  • Nurse Practitioner
  • Bolivia, NC
  • NPI 1366798209
  NPD (past)

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

{
    "created_epoch": "1332115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718928000000",
    "number": "1982979399",
    "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": "910-721-4150",
            "fax_number": "910-721-4159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "584 HOSPITAL DR NE",
            "address_2": "SUITE D",
            "city": "BOLIVIA",
            "state": "NC",
            "postal_code": "284229047",
            "telephone_number": "910-721-4150",
            "fax_number": "910-721-4159"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "257 Hospital Dr. NE Ste 100",
            "address_purpose": "LOCATION",
            "city": "Bolivia",
            "state": "NC",
            "postal_code": "284228411",
            "country_code": "US",
            "telephone_number": "910-721-4150",
            "fax_number": "910-721-4159",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NOVANT HEALTH MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-19",
        "last_updated": "2024-06-21",
        "certification_date": "2024-06-21",
        "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": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Urology Partners",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Novant Health Urology Partners",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Novant Health Medical Group, LLC
• Novant Health Medical Group, LLC
• Novant Health Medical Group, LLC
• Novant Health Medical Group, LLC
• Novant Health Medical Group, LLC
• Novant Medical Group, Inc.
• Steven Christopher Nunns, M.D.
• Maureen E O'Brien, P.T.
• Jaclyn J Oehler, MS, CCC-SLP
• Sabrina Rohanie Officer, DMD

• Urology Physician in Bolivia, NC
• Providers in Bolivia, NC by specialty
• Urology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 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.