NOVANT MEDICAL GROUP, INC (NPI# 1376092056) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376092056 |
| Entity Type | Organization |
| Organization Name | NOVANT MEDICAL GROUP, INC |
| Other Organization Name | NOVANT HEALTH INTENSIVE DIABETES MANAGEMENT |
| Practice Address |
1400 Westgate Center Drive Suite 130 Winston Salem NC 27103-3104 |
| Mailing Address |
Po Box 60447 Charlotte NC 28260-0447 |
| Practice Telephone | 3366598703 |
| Practice Fax Number | 3366598704 |
| Mailing Telephone | 3366598703 |
| Mailing Fax Number | 3366598704 |
| Enumeration Date | 2016-09-23 |
| Last Update Date | 2017-01-27 |
| Authorized Official Name | GEOFF K GARDNER (VP OF FINANCE) |
| Authorized Official Telephone | 7043849672 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RE0101X |
Internal Medicine Specialization: Endocrinology, Diabetes & Metabolism |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Novant Health Intensive Diabetes Management | 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 |
1400 WESTGATE CENTER DRIVE SUITE 130 |
| City | WINSTON SALEM |
| State | NC |
| Zip Code | 27103-3104 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023000676 | Kellie A Faulk | Internal Medicine | 1400 Westgate Center Drive, Suite 130, Winston Salem, NC 27103-3104 | 2005-08-19 |
| 1659678787 | Barium Springs Home for Children | Social Worker | 1400 Westgate Center Drive, Suite 100, Winston Salem, NC 27103 | 2011-02-25 |
| 1144242256 | Wanda Elliott Rushton | Nurse Practitioner | 1400 Westgate Center Drive, Suite 130, Winston Salem, NC 27103-3104 | 2006-07-25 |
| 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 | 207RE0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Endocrinology, Diabetes & Metabolism |
| An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174813570 | Chinenyenwa Usoh | Internal Medicine | 4610 Country Club Rd, Winston Salem, NC 27104-3520 | 2011-04-19 |
| 1730301037 | Jaime E Trujillo Md Pa | Internal Medicine | 3080 Trenwest Drive, Winston Salem, NC 27103 | 2007-05-03 |
| 1023104981 | Tracie Christine Farmer | Internal Medicine | 755 Highland Oaks Dr Ste 201, Dba Forsyth Endocrine Consultants, Winston Salem, NC 27103-7106 | 2006-10-05 |
| 1457336893 | Larry Keith Cantley | Internal Medicine | 755 Highland Oaks Dr, Suite 201, Winston Salem, NC 27103-7106 | 2005-12-08 |
| 1023000676 | Kellie A Faulk | Internal Medicine | 1400 Westgate Center Drive, Suite 130, Winston Salem, NC 27103-3104 | 2005-08-19 |
| 1982023172 | Matthew Gorris | Internal Medicine | Medical Center Blvd, Winston Salem, NC 27157-0001 | 2014-04-15 |
| 1740627496 | Mark Vincent Guido | Internal Medicine | 755 Highland Oaks Dr Ste 201, Winston Salem, NC 27103 | 2013-06-03 |
| 1801026810 | Pooja Raghavan | Internal Medicine | 755 Highland Oaks Dr, Ste 201, Winston Salem, NC 27103-7106 | 2009-07-24 |
| 1437320959 | Kavya Chitra Mekala | Internal Medicine | Medical Center Blvd, Section On Endocrinology, E Floor Nutrition Building, Winston Salem, NC 27157-0001 | 2008-03-13 |
| 1760663579 | Amanda Ring Cunningham | Internal Medicine | Medical Center Blvd, Endocrinology, Winston Salem, NC 27157-0001 | 2007-11-20 |
| 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.