Active NPI
Novant Medical Group, Inc.
- Internal Medicine Physician
- Raleigh, NC
National Provider Identifier
1992019525
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 9401116
- Legal business name
- NOVANT MEDICAL GROUP, INC.
- Practice address
- 701 Exposition PL
Suite 218
Raleigh, NC 27615-3300 - Phone
- (919) 791-2900
- Fax
- (919) 845-2568
- NPI assigned
- Aug 6, 2010
- Organization subpart
- Yes
- Parent organization
- NOVANT MEDICAL
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Geoffrey K Gardner
- Title
- VP of Finance
- Phone
- (704) 384-9094
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 9401116 | NC | Primary |
Addresses
Primary practice location
701 Exposition PL
Suite 218
Raleigh, NC 27615-3300
Mailing address
PO Box 602362
Charlotte, NC 28260-2362
Phone (704) 384-7840
Other names 1
- Neuse Valley Internal Medicine
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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- Part of
- Presbyterian Inpt Care
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1281052800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1281052800000",
"number": "1992019525",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 602362",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282602362",
"telephone_number": "704-384-7840",
"fax_number": "704-384-7830"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 EXPOSITION PL",
"address_2": "SUITE 218",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276153300",
"telephone_number": "919-791-2900",
"fax_number": "919-845-2568"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NOVANT MEDICAL GROUP, INC.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "NOVANT MEDICAL",
"enumeration_date": "2010-08-06",
"last_updated": "2010-08-06",
"status": "A",
"authorized_official_last_name": "GARDNER",
"authorized_official_first_name": "GEOFFREY",
"authorized_official_middle_name": "K",
"authorized_official_title_or_position": "VP OF FINANCE",
"authorized_official_telephone_number": "704-384-9094"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": "NC",
"license": "9401116",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Neuse Valley Internal Medicine",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2010; 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.