NOVANT MEDICAL GROUP, INC. (NPI# 1205899861) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205899861 |
| Entity Type | Organization |
| Organization Name | NOVANT MEDICAL GROUP, INC. |
| Other Organization Name | NOVANT HEALTH FORT MILL FAMILY MEDICINE |
| Practice Address |
1690 Highway 160 W Fort Mill SC 29708-8024 |
| Mailing Address |
Po Box 602362 Charlotte NC 28260-2362 |
| Practice Telephone | 8035477541 |
| Practice Fax Number | 8035480122 |
| Mailing Telephone | 7043847840 |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2013-06-27 |
| Authorized Official Name | GEOFFREY GARDNER (VP OF OPERATIONS) |
| Authorized Official Telephone | 7043849094 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | GP4288 | 05 |
| Other Name | Type Code |
|---|---|
| Novant Health Fort Mill Family Medicine | 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 |
1690 HIGHWAY 160 W |
| City | FORT MILL |
| State | SC |
| Zip Code | 29708-8024 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811962574 | James C Jordan | Family Medicine | 1690 Highway 160 W, Fort Mill, SC 29708-8024 | 2006-02-17 |
| 1518570761 | Carolinas Physicians Network Inc | Orthopaedic Surgery | 1690 Highway 160 W, Fort Mill, SC 29708-8024 | 2020-08-27 |
| 1881049104 | Carolinas Physicians Network, Inc. | Orthopaedic Surgery | 1690 Highway 160 W, Fort Mill, SC 29708-8024 | 2016-04-25 |
| 1689004376 | Pmc Physician Network, L.L.C. | Family Medicine | 1690 Highway 160 W, Fort Mill, SC 29708-8024 | 2013-11-18 |
| 1083677124 | Kenneth Edward Nunnery | Family Medicine | 1690 Highway 160 W, Fort Mill, SC 29708-8024 | 2006-04-10 |
| 1154384725 | George Marshall Yearta | Family Medicine | 1690 Highway 160 W, Fort Mill, SC 29708-8024 | 2006-04-06 |
| 1962465518 | Dean Barry Adelman | Family Medicine | 1690 Highway 160 W, Fort Mill, SC 29708-8024 | 2006-04-06 |
| 1952364515 | James Loring Bergman | Family Medicine | 1690 Highway 160 W, Fort Mill, SC 29708-8024 | 2006-04-06 |
| 1053387019 | Ann Elizabeth Meyer | Family Medicine | 1690 Highway 160 W, Fort Mill, SC 29708-8024 | 2006-02-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265089098 | Jennifer Priory O'keefe | Nurse Practitioner | 117 Stone Village Dr., Fort Mill, SC 29708 | 2019-08-26 |
| 1144790577 | Mary Kathleen Gerber | Speech-Language Pathologist | 1874 Second Baxter Crossing, Fort Mill, SC 29708 | 2018-11-28 |
| 1275016263 | R.e. Offutt, Dds, Ms and B.l. Cockerham Dds, Msp, Pllc | Dentist | 929 Market St, Fort Mill, SC 29708 | 2018-09-14 |
| 1861985384 | Hf Care Services LLC | Counselor | 150 B.w. Thomas Dr., 108, Fort Mills, SC 29708 | 2018-06-09 |
| 1134619802 | Myeyedr Optometry of South Carolina, LLC | Optometrist | 1826 Highway 160 W Ste 101, Fort Mill, SC 29708 | 2018-05-17 |
| 1255832549 | Lakeshore Dental Inc. | Dentist | 1200 Gold Hill Road, Fort Mill, SC 29708 | 2018-02-22 |
| 1407362338 | Smith Physical Therapy and Wellness | Physical Therapist | 2435 Highway 160 West, Suite 108, Tega Cay, SC 29708 | 2017-12-14 |
| 1841704244 | Modern Concepts, LLC | General Practice | 1808 Second Baxter Xing Ste 108, Fort Mill, SC 29708 | 2017-11-21 |
| 1942729355 | Alexis Rose Muttillo | Specialist/Technologist | 1054 Cameron Creek Pkwy, Tega Cay, SC 29708 | 2017-09-18 |
| 1407308208 | Brenda Terry | Acupuncturist | 1171 Market Street, Ste # 112, Fort Mill, SC 29708 | 2016-10-27 |
| Find all providers in zip 29708 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639542699 | Affinity Health Center | Family Medicine | 120 Elliott St E, Fort Mill, SC 29715-1848 | 2015-11-12 |
| 1932336542 | Smitha M Ballyamanda | Family Medicine | 515 Rivercrossing Dr, Suite 180, Fort Mill, SC 29715-7900 | 2009-06-22 |
| 1942409651 | Katrina Herring | Family Medicine | 773 Stockbridge Dr, Fort Mill, SC 29708-7200 | 2007-07-12 |
| 1558462085 | Arnold B Campo | Family Medicine | 377 Rubin Center Dr, Suite 110, Fort Mill, SC 29708-7275 | 2006-09-26 |
| 1407863343 | Piedmont Family Practice At Tega Cay, LLC | Family Medicine | 773 Stockbridge Drive, Fort Mill, SC 29708 | 2006-08-02 |
| 1144288796 | David M Mobley | Family Medicine | 502 6th Baxter Crossing, Fort Mill, SC 29708 | 2006-05-03 |
| 1811962574 | James C Jordan | Family Medicine | 1690 Highway 160 W, Fort Mill, SC 29708-8024 | 2006-02-17 |
| 1114999737 | Lance M Gowen | Family Medicine | 515 Rivercrossing Dr Ste 180, Fort Mill, SC 29715-7900 | 2006-02-07 |
| 1760462311 | Jennifer C Dickens | Family Medicine | 113 Millwood Dr, Fort Mill, SC 29715-8356 | 2006-01-19 |
| 1043819535 | Carolinas Physicians Network Inc | Family Medicine | 9623 Redstone Dr Ste 300, Fort Mill, SC 29707-5407 | 2020-10-26 |
| Find all providers in FORT MILL | ||||
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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.