NOVANT MEDICAL GROUP, INC. (NPI# 1235798992) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235798992 |
| Entity Type | Organization |
| Organization Name | NOVANT MEDICAL GROUP, INC. |
| Practice Address |
20 Medical Campus Dr Nw Ste 205 Supply NC 28462-4094 |
| Mailing Address |
Po Box 60447 Charlotte NC 28260-0447 |
| Practice Telephone | 7043840517 |
| Enumeration Date | 2019-06-06 |
| Last Update Date | 2019-06-06 |
| Authorized Official Name | SHALA DAVIS (MANAGER OF MANAGED CARE) |
| Authorized Official Telephone | 7043167845 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Novant Health Pediatrics Brunswick | 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 |
20 MEDICAL CAMPUS DR NW STE 205 |
| City | SUPPLY |
| State | NC |
| Zip Code | 28462-4094 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497752968 | Lori Anne Tackman | Pediatrics | 20 Medical Campus Dr Nw Ste 205, Supply, NC 28462 | 2005-06-30 |
| 1396124467 | Kaylan Elizabeth Edwards | Pediatrics | 20 Medical Campus Dr Nw Ste 205, Supply, NC 28462 | 2015-05-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558910943 | Lisa M Jock | Technician | 1276 Skipper Run Sw, Supply, NC 28462 | 2019-09-09 |
| 1023532686 | Novant Health Brunswick Endoscopy Center, LLC | Nurse Anesthetist, Certified Registered | 13 Medical Campus Drive, Suite 101, Supply, NC 28462 | 2017-07-26 |
| 1821510579 | Novant Health Brunswick Endoscopy Center, LLC | Clinic/Center | 13 Medical Campus Dr, Suite 101, Supply, NC 28462 | 2017-07-14 |
| 1831461920 | Reginald Lofton Hewett | Counselor | 1473 Cedar Grove Rd, Supply, NC 28462 | 2012-02-03 |
| 1760793343 | Coastal Hearing Centers, Inc | Clinic/Center | 2298 Ocean Hwy, Supply, NC 28462 | 2010-06-29 |
| 1083943567 | Lorell Sneeden Pait | Nurse Practitioner | 795 Ocean Highway West, Supply, NC 28462 | 2009-12-14 |
| 1043451321 | Well Care Home Care | Home Health | 118 Ocean Highway West, Supply, NC 28462 | 2009-03-16 |
| 1467672873 | South Atlantic Radiation Oncology, LLC | Clinic/Center | 545 Ocean Highway West, Supply, NC 28462 | 2007-04-26 |
| 1225177702 | Barbara C Bauer | Counselor | 1041 Old Ocean Highway, Supply, NC 28462 | 2007-02-05 |
| 1891852323 | Liberty Medical Specialties, Inc | Durable Medical Equipment & Medical Supplies | 1120 Ocean Hwy West, Supply, NC 28462 | 2007-01-03 |
| Find all providers in zip 28462 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| 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/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497752968 | Lori Anne Tackman | Pediatrics | 20 Medical Campus Dr Nw Ste 205, Supply, NC 28462 | 2005-06-30 |
| 1396124467 | Kaylan Elizabeth Edwards | Pediatrics | 20 Medical Campus Dr Nw Ste 205, Supply, NC 28462 | 2015-05-22 |
| 1972823615 | Novant Medical Group Inc | Pediatrics | 10 Doctors Cir, Suite 6, Supply, NC 28462-4217 | 2010-06-04 |
| 1750420428 | Shore Fun Pediatrics | Pediatrics | 14 Doctors Cir, Suite 3, Supply, NC 28462-4097 | 2007-02-06 |
| 1790797108 | Joanne Peck | Pediatrics | 14 Doctors Cir, Suite 3, Supply, NC 28462-4097 | 2006-08-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124627146 | Kidzcare Pediatrics, PC | Pediatrics | Kidzcare Pediatrics, PC, 312 South Mccaskey Road, Williamston, NC 27892-2150 | 2020-10-21 |
| 1619582343 | Carolinas Physicians Network Inc | Pediatrics | 9908 Couloak Dr Ste 103, Charlotte, NC 28216-8678 | 2020-09-10 |
| 1992310627 | Carolinas Physicians Network Inc | Pediatrics | 1585 Forney Creek Pkwy Ste 2100, Denver, NC 28037-9520 | 2020-09-10 |
| 1861004426 | Carolinas Physicians Network Inc | Pediatrics | 4501 Cameron Valley Pkwy Ste 200-b, Charlotte, NC 28211-4297 | 2020-08-17 |
| 1871114470 | Kidzcare Pediatrics, PC | Pediatrics | 327 W College Ave, Shelby, NC 28152-8111 | 2020-05-05 |
| 1568082212 | Kidzcare Pediatrics, PC | Pediatrics | 416 Mccullough Dr Ste 140, Charlotte, NC 28262-4390 | 2020-04-23 |
| 1881222404 | Victoria Marie Carvajal | Pediatrics | Cmc/levine's Children's Hospital 1000 Blythe Blvd, 4th Floor, Meb, Charlotte, NC 28203-8812 | 2020-03-30 |
| 1386271930 | Irina Maria Geiculescu | Pediatrics | 1000 Blythe Blvd Fl 4 Meb, Charlotte, NC 28203 | 2020-03-24 |
| 1689201568 | Mark Selna | Pediatrics | 13 Weybridge Pl, Chapel Hill, NC 27517-8938 | 2020-03-23 |
| 1407488349 | Beth A Scisciani | Pediatrics | 8654 Walsham Dr, Charlotte, NC 28277-1850 | 2020-02-09 |
| Find all providers with the same taxonomy | ||||
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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.