Novant Medical Group, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

NOVANT MEDICAL GROUP, INC.

Practice address

9929 Rea Rd.
Ste 101
Waxhaw, NC 28173-6439

Phone

(704) 316-1075

Fax

(704) 316-1076

NPI assigned

Dec 16, 2018

Organization subpart

No

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

Authorized official

Name

Shala Davis

Title

Manager

Phone

(704) 316-7845

Specialties & licenses 1

Addresses

Other names 1

• Novant Health Primary Care Marvin Creek Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Practitioners 2

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

• Russell David Davis, PA

  • Physician Assistant
  • Clemmons, NC
  • NPI 1669119145
  NPD
• Rachael Cathrynn Gravel, PA

  • Physician Assistant
  • Salisbury, NC
  • NPI 1972234409
  NPD

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

{
    "created_epoch": "1544918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553731200000",
    "number": "1992276950",
    "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": "844-266-8268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9929 REA RD.",
            "address_2": "STE 101",
            "city": "WAXHAW",
            "state": "NC",
            "postal_code": "281736439",
            "telephone_number": "704-316-1075",
            "fax_number": "704-316-1076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVANT MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-16",
        "last_updated": "2019-03-28",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "SHALA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "704-316-7845"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Novant Health Primary Care Marvin Creek",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Novant Health Primary Care Marvin Creek",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Novant Health Medical Group, LLC
• Novant Health Medical Group, LLC
• Novant Health Medical Group, LLC
• Novant Medical Group, Inc
• Novant Medical Group, Inc.
• Isioma Nwaeme-Ngidi, FNP
• Stephanie Wolla O'Connell, DPT
• Taylor Rae O'Toole, OTR/L
• Oasis Total Development, Inc.
• Occupational Therapy South

• Family Medicine Physician in Waxhaw, NC
• Providers in Waxhaw, NC by specialty
• Family Medicine Physician in North Carolina

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