NOVANT MEDICAL GROUP, INC (NPI# 1083015028) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083015028 |
| Entity Type | Organization |
| Organization Name | NOVANT MEDICAL GROUP, INC |
| Other Organization Name | NOVANT HEALTH PEDIATRIC CARDIOLOGY |
| Practice Address |
11840 Southmore Dr Suite 201 Charlotte NC 28277-4466 |
| Mailing Address |
Po Box 60447 Charlotte NC 28260-0447 |
| Practice Telephone | 7043161220 |
| Practice Fax Number | 7043161230 |
| Mailing Telephone | 7043161220 |
| Mailing Fax Number | 7043161230 |
| Enumeration Date | 2014-09-09 |
| Last Update Date | 2016-07-21 |
| Authorized Official Name | GEOFFREY K GARDNER (VP OF FINANCE) |
| Authorized Official Telephone | 7043847606 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians | ||
| Y | 2080P0202X |
Pediatrics Specialization: Pediatric Cardiology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 1083015028 | 05 |
| Other Name | Type Code |
|---|---|
| Novant Health Pediatric Cardiology | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962048512 | Novant Medical Group, Inc | Family Medicine | 1400 Westgate Ctr Dr Ste 110, Winston Salem, NC 27103-3104 | 2019-11-19 |
| 1710444294 | Novant Medical Group, Inc | Orthopaedic Surgery | 167 Moore Rd Ste 202, King, NC 27021-8770 | 2019-02-21 |
| 1033698527 | Novant Medical Group, Inc | Internal Medicine | 8201 Healthcare Loop Ste 304, Charlotte, NC 28215 | 2018-08-07 |
| 1114411139 | Novant Medical Group, Inc | Internal Medicine | 8201 Healthcare Loop Ste 202, Charlotte, NC 28215-7072 | 2018-06-22 |
| 1649786575 | Novant Medical Group, Inc | Physical Therapist | 8045 Providence Rd Ste 100, Charlotte, NC 28277-8916 | 2017-12-14 |
| 1962953877 | Novant Medical Group, Inc | Internal Medicine | 9550 Rocky River Rd Ste 100, Charlotte, NC 28215 | 2016-10-17 |
| 1063963080 | Novant Medical Group, Inc | Urology | 1730 Kernersville Medical Pkwy Ste 303, Kernersville, NC 27284-7198 | 2016-10-14 |
| 1265807937 | Novant Medical Group, Inc | Orthopaedic Surgery | 1420 Us Highway 52, Suite B, Albemarle, NC 28001 | 2015-12-07 |
| 1881096907 | Novant Medical Group, Inc | Internal Medicine | 17810 Statesville Rd Ste 311, Cornelius, NC 28031-8149 | 2014-09-19 |
| 1548661606 | Novant Medical Group, Inc | Orthopaedic Surgery | 7138 Village Medical Circle, Clemmons, NC 27012 | 2014-09-09 |
| 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 201 |
| 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 |
| 1013453604 | Novant Medical Group, Inc. | Pediatrics | 11840 Southmore Dr, Suite 200, Charlotte, NC 28277-4466 | 2017-01-06 |
| 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 |
| 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 | 2080P0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Cardiology |
| A pediatric cardiologist provides comprehensive care to patients with cardiovascular problems. This specialist is skilled in selecting, performing and evaluating the structural and functional assessment of the heart and blood vessels, and the clinical evaluation of cardiovascular disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pediatrics. The Certification is no longer offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952626376 | Carolinas Physicians Network, Inc. | Pediatrics | 14214 Ballantyne Lake Road, Suite 150, Charlotte, NC 28277-3373 | 2010-03-29 |
| 1114152469 | Frances Chen Travelli | Pediatrics | 1718 E 4th St Ste 605, Charlotte, NC 28204-3282 | 2009-05-15 |
| 1861978785 | Novant Medical Group, Inc. | Pediatrics | 6331 Carmel Rd Ste 102, Charlotte, NC 28226-8246 | 2018-07-13 |
| 1306117346 | Jennifer Bailey | Pediatrics | 1001 Blythe Blvd, Ste 200d, Charlotte, NC 28203-5866 | 2012-01-23 |
| 1730409046 | Aaron Prosnitz | Pediatrics | 1001 Blythe Blvd, Ste 200d, Charlotte, NC 28203-5866 | 2010-06-09 |
| 1881919306 | Carolinas Physicians Network, Inc. | Pediatrics | 1000 Blythe Blvd Fl 4, Charlotte, NC 28203-5812 | 2010-03-29 |
| 1639339450 | Matthew Brothers | Pediatrics | 1718 E 4th St, Suite 605, Charlotte, NC 28204-3261 | 2008-06-16 |
| 1417179078 | Gonzalo Wallis | Pediatrics | 1001 Blythe Blvd, Ste 200d, Charlotte, NC 28203-5866 | 2007-05-03 |
| 1811068281 | James Herlong | Pediatrics | 1001 Blythe Blvd, Ste 200d, Charlotte, NC 28203-5866 | 2006-11-10 |
| 1659382059 | William Wallace Hammill | Pediatrics | 1718 E 4th St, Suite 401, Charlotte, NC 28204-3261 | 2006-08-10 |
| 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.