NOVANT MEDICAL GROUP, INC. (NPI# 1114250354) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114250354 |
| Entity Type | Organization |
| Organization Name | NOVANT MEDICAL GROUP, INC. |
| Other Organization Name | NOVANT HEALTH SALEM SURGICAL ASSOCIATES |
| Practice Address |
2915 Lyndhurst Ave Winston Salem NC 27103-4005 |
| Mailing Address |
Po Box 60447 Charlotte NC 28260-0447 |
| Practice Telephone | 3367655221 |
| Practice Fax Number | 3367650430 |
| Mailing Telephone | 3367655221 |
| Mailing Fax Number | 3367650430 |
| Enumeration Date | 2009-09-04 |
| Last Update Date | 2015-03-18 |
| Authorized Official Name | MR. GEOFFREY K. GARDNER (VP OF FINANCE) |
| Authorized Official Telephone | 7043847283 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2086S0129X |
Surgery Specialization: Vascular Surgery |
Allopathic & Osteopathic Physicians | ||
| Y | 208600000X | Surgery | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Novant Health Salem Surgical Associates | 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 |
2915 LYNDHURST AVE |
| City | WINSTON SALEM |
| State | NC |
| Zip Code | 27103-4005 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548620719 | Kevin Spainhour | Nurse Practitioner | 2915 Lyndhurst Ave, Winston Salem, NC 27103-4005 | 2016-03-02 |
| 1891175956 | Novant Medical Group Inc | Surgery | 2915 Lyndhurst Ave, Winston Salem, NC 27103-4005 | 2015-06-04 |
| 1881913176 | Christopher Hunter | Surgery | 2915 Lyndhurst Ave, Winston Salem, NC 27103-4005 | 2010-05-26 |
| 1841477015 | Jennifer Christman | Surgery | 2915 Lyndhurst Ave, Winston Salem, NC 27103-4005 | 2008-01-29 |
| 1851577340 | Niki S Faircloth | Physical Therapist | 2915 Lyndhurst Ave, Winston Salem, NC 27103-4005 | 2008-01-14 |
| 1104945864 | Diego Fernando Pabon | Surgery | 2915 Lyndhurst Ave, Winston Salem, NC 27103-4005 | 2007-03-27 |
| 1568418788 | Lisa D Darby-obar | Physician Assistant | 2915 Lyndhurst Ave, Winston Salem, NC 27103-4005 | 2006-05-26 |
| 1972555621 | Julio H Reyes | Surgery | 2915 Lyndhurst Ave, Winston Salem, NC 27103-4005 | 2006-05-17 |
| 1144286923 | Salem Surgical Assocs Pa | Surgery | 2915 Lyndhurst Ave, Winston Salem, NC 27103-4005 | 2006-04-21 |
| 1447212667 | Samuel Patrick Stuart Jr. | Specialist | 2915 Lyndhurst Ave, Winston Salem, NC 27103-4005 | 2006-04-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124648126 | Kelly Anne Wales | Pharmacist | 3917-a Westpoint Boulevard, Winston-salem, NC 27103 | 2020-04-20 |
| 1386281533 | Elena Mcginty | Nurse Practitioner | 1225 Creekshire Way, Suite 270, Winston Salem, NC 27103 | 2019-12-06 |
| 1992359442 | Madeline Pryor | Pharmacist | 255 Charlois Drive, Winston Salem, NC 27103 | 2019-08-01 |
| 1215599584 | Palmetto Oxygen LLC | Durable Medical Equipment & Medical Supplies | 1100 S Stratford Road, Building B, Suite 420, Winston Salem, NC 27103 | 2019-07-07 |
| 1548734718 | Trivy Johnson | Specialist | 1384-b Westgate Center Dr., Winston Salem, NC 27103 | 2019-01-21 |
| 1447745047 | Novant Health Rehabilitation Hospital of Winston-salem, LLC | Rehabilitation Hospital | 2475 Hillcrest Center Circle, Winston Salem, NC 27103 | 2018-06-26 |
| 1346740206 | Joseph Miller | Physical Therapist | 1605 Westbrook Dr, Suite 103, Winston-salem, NC 27103 | 2018-02-17 |
| 1548779101 | Kristin Blow | Counselor | 3000 Bethesda Pl Ste 202, Winston Salem, NC 27103 | 2017-09-27 |
| 1891213443 | Alisha Dawn Wilson | Occupational Therapy Assistant | 2101 Homestead Hills Drive, Winston Salem, NC 27103 | 2017-09-05 |
| 1588186969 | Brandy Wilson | Social Worker | 153 Cameron Way Circle, Winston Salem, NC 27103 | 2017-07-07 |
| Find all providers in zip 27103 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| 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 Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386128601 | Venkateswara Rao Gurram | Surgery | 5075 Winster Dr Apt 202, Winston Salem, NC 27106-2988 | 2018-09-21 |
| 1376981217 | Kathryn Starr Sobba | Surgery | Wake Forest Baptist Health General Surgery, Medical Center Boulevard, Winston Salem, NC 27157-0001 | 2013-06-13 |
| 1548550544 | David Johnson Hiller | Surgery | 2825 Lyndhurst Ave Ste 101, Winston Salem, NC 27103-4146 | 2011-04-11 |
| 1144481029 | Baogang Liu | Surgery | Medical Central Blvd, Winston Salem, NC 27157-0001 | 2008-06-23 |
| 1699955427 | Joel Krishna Deonanan | Surgery | 2827 Lyndhurst Ave Ste 203, Winston Salem, NC 27103-4145 | 2007-11-08 |
| 1720094352 | Earll Parks Welch | Surgery | 2850 Merry Acres Ln, Winston Salem, NC 27106-5743 | 2006-08-01 |
| 1114984267 | George William Haggerson | Surgery | 3318 Healy Dr, Winston Salem, NC 27103-1404 | 2006-05-01 |
| 1437119302 | Stanley B. Fuller | Surgery | 2825 Lyndhurst Ave, Ste 101, Winston Salem, NC 27103-4146 | 2006-03-24 |
| 1164481685 | Claude Raymond Workman | Surgery | 2827 Lyndhurst Ave, Suite 203, Winston Salem, NC 27103-4145 | 2006-03-22 |
| 1578044558 | Sue Adkins Fitzko | Surgery | 1 Medical Center Boulevard, Winston Salem, NC 27157 | 2018-08-27 |
| Find all providers in WINSTON SALEM | ||||
| City | WINSTON SALEM |
| Zip Code | 27103 |
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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.