NOVANT MEDICAL GROUP, INC. (NPI# 1013453604) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013453604 |
| Entity Type | Organization |
| Organization Name | NOVANT MEDICAL GROUP, INC. |
| Other Organization Name | NOVANT HEALTH PEDIATRIC GASTROENTEROLOGY |
| Practice Address |
11840 Southmore Dr Suite 200 Charlotte NC 28277-4466 |
| Mailing Address |
Po Box 60447 Charlotte NC 28260-0447 |
| Practice Telephone | 7043165060 |
| Practice Fax Number | 7043165069 |
| Mailing Telephone | 7043165060 |
| Mailing Fax Number | 7043165069 |
| Enumeration Date | 2017-01-06 |
| Last Update Date | 2017-01-06 |
| Authorized Official Name | MR. GEOFFREY K GARDNER (VP FINANCE) |
| Authorized Official Telephone | 7043847840 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0206X |
Pediatrics Specialization: Pediatric Gastroenterology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Novant Health Pediatric Gastroenterology | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033723531 | Novant Medical Group, Inc. | Surgery | 1450 Matthews Township Pkwy Ste 320, Matthews, NC 28105-2389 | 2020-09-02 |
| 1346868155 | Novant Medical Group, Inc. | Family Medicine | 106 Corporate Park Dr Ste 200, Mooresville, NC 28117-7134 | 2020-07-08 |
| 1861019150 | Novant Medical Group, Inc. | Family Medicine | 2701 Statesville Ave., Charlotte, NC 28206 | 2020-07-02 |
| 1932725124 | Novant Medical Group, Inc. | Internal Medicine | 125 Queens Rd Ste 510, Charlotte, NC 28204-3215 | 2020-06-23 |
| 1922645571 | Novant Medical Group, Inc. | Surgery | 6324 Fairview Rd Ste 420, Charlotte, NC 28210-3372 | 2019-12-03 |
| 1437706256 | Novant Medical Group, Inc. | Physical Therapist | 11202 Harris Rd, Huntersville, NC 28078-7633 | 2019-08-26 |
| 1336795137 | Novant Medical Group, Inc. | Surgery | 3515 W Market St Ste 310, Greensboro, NC 27403-4438 | 2019-08-16 |
| 1104472125 | Novant Medical Group, Inc. | Neurological Surgery | 3515 W Market St Ste 210, Greensboro, NC 27403-4442 | 2019-08-15 |
| 1649824954 | Novant Medical Group, Inc. | Family Medicine | 6555 Kee Lane, Harrisburg, NC 28075-7463 | 2019-07-25 |
| 1285287185 | Novant Medical Group, Inc. | Lactation Consultant, Non-RN | 6324 Fairview Rd Ste 435, Charlotte, NC 28210-4278 | 2019-07-19 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | NOVANT MEDICAL GROUP, INC. | 200 Hawthorne Ln, Charlotte, NC 28204-2515 |
| Street Address |
11840 SOUTHMORE DR SUITE 200 |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28277-4466 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255315529 | Kristin Michelle Hietbrink | Physical Therapist | 11840 Southmore Dr, Suite 100, Charlotte, NC 28277-4466 | 2005-12-01 |
| 1962957555 | Novant Medical Group, Inc | Psychiatry & Neurology | 11840 Southmore Dr, Suite 201, Charlotte, NC 28277-4466 | 2016-08-24 |
| 1700236023 | G Abrams & R Cohen Xv PC | Dentist | 11840 Southmore Dr, Suite 150, Charlotte, NC 28277-4466 | 2016-06-17 |
| 1013386895 | Carolina Medicorp Enterprises, Inc | Family Medicine | 11840 Southmore Dr, Suite 100, Charlotte, NC 28277-4466 | 2015-09-22 |
| 1083015028 | Novant Medical Group, Inc | Internal Medicine | 11840 Southmore Dr, Suite 201, Charlotte, NC 28277-4466 | 2014-09-09 |
| 1063766848 | Omolara Layeni | Physician Assistant | 11840 Southmore Dr, Suite 100, Charlotte, NC 28277 | 2012-11-01 |
| 1043566680 | Molly Elizabeth Capella | Physical Therapist | 11840 Southmore Dr, Suite 100, Charlotte, NC 28277-4466 | 2012-08-01 |
| 1235401035 | Eric R Ford | Physical Therapist | 11840 Southmore Dr, Suite 100, Charlotte, NC 28277-4466 | 2012-02-08 |
| 1992091466 | Daryl Palmer | Physical Therapist | 11840 Southmore Dr, Suite 100, Charlotte, NC 28277-4466 | 2011-06-23 |
| 1649596768 | Michael A. Rosenberg | Physical Therapist | 11840 Southmore Dr, Suite 100, Charlotte, NC 28277-4466 | 2010-04-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255949731 | New Life Peer Support and Coaching LLC | Clinic/Center | 3450 Toringdon Way, Suite 200, Charlotte, NC 28277 | 2020-07-21 |
| 1083256762 | Speak Life Counseling Services, Pllc | Counselor | 16147 Lacaster Hwy, Suite 110, Charlotte, NC 28277 | 2019-10-14 |
| 1275010019 | Jigneshkumar R Mistry | Pharmacist | 11805 Allforth Ln Apt 2105, Charlotte, NC 28277 | 2018-07-24 |
| 1255825410 | Novant Medical Group Inc. | Family Medicine | 15033 Balloncroft Parkway, Suite 200, Charlotte, NC 28277 | 2018-06-20 |
| 1447752316 | Harris Teeter LLC | Durable Medical Equipment & Medical Supplies | 11135 Golf Links Dr, Charlotte, NC 28277 | 2018-03-06 |
| 1932607595 | Charlotte Proactive Md PC | Clinic/Center | 11220 Golf Links Drive North, Charlotte, NC 28277 | 2018-01-30 |
| 1003331521 | Accela Spine and Pain, Pllc | Anesthesiology | 10120 Ivey Chase Lane, Apt 617, Charlotte, NC 28277 | 2017-08-04 |
| 1265961619 | Dominicka Whitaker | Counselor | 12365 Bluestem Ln., Charlotte, NC 28277 | 2017-06-08 |
| 1083143408 | Monika D Hayes | Counselor | 11330 Snapfinger Drive, Charlotte, NC 28277 | 2017-06-08 |
| 1225582984 | Danielle Mcdaniel | Occupational Therapist | 5113 Piper Station Dr Ste 103, Charlotte, NC 28277 | 2016-08-11 |
| Find all providers in zip 28277 | ||||
| Taxonomy Code | 2080P0206X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Gastroenterology |
| A pediatrician who specializes in the diagnosis and treatment of diseases of the digestive systems of infants, children and adolescents. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using lighted scopes to see internal organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912286410 | Carolinas Medical Center-northeast | Pediatrics | 101 East W T Harris Blvd, Bldg 3000, Suite 3301e, Charlotte, NC 28262-7000 | 2011-08-15 |
| 1013296730 | Timothy Menz | Pediatrics | 2711 Randolph Rd Ste 301, Charlotte, NC 28207-2027 | 2011-08-11 |
| 1770979353 | Novant Medical Group, Inc. | Pediatrics | 13557 Steelecroft Pkwy, Suite 2200, Charlotte, NC 28278-0057 | 2015-04-10 |
| 1164705653 | Novant Medical Group Inc | Pediatrics | 16139 Lancaster Hwy, Suite 110, Charlotte, NC 28277-2033 | 2011-09-21 |
| 1194911123 | Jason Dranove | Pediatrics | 1001 Blythe Blvd, Medical Center Plaza Suite 200, Charlotte, NC 28203-5866 | 2007-09-24 |
| 1386851590 | Melanie K Rhue | Pediatrics | 2711 Randolph Rd, Suite 301, Charlotte, NC 28207-2034 | 2007-05-17 |
| 1740312909 | Ameesh Shah | Pediatrics | 1001 Blythe Blvd, Medical Center Plaza Suite 200, Charlotte, NC 28203-5866 | 2007-03-12 |
| 1003966185 | Novant Medical Group, Inc. | Pediatrics | 2711 Randolph Rd, Suite 301, Charlotte, NC 28207-2027 | 2007-01-11 |
| 1205910734 | Tiffany Linville | Pediatrics | 1001 Blythe Blvd, Medical Center Plaza Suite 200, Charlotte, NC 28203-5866 | 2006-10-24 |
| 1568552206 | Vani Gopalareddy | Pediatrics | 1350 S Kings Dr, Charlotte, NC 28207-2134 | 2006-10-13 |
| Find all providers in CHARLOTTE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.