NOVANT MEDICAL GROUP, INC. (NPI# 1699095331) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699095331 |
| Entity Type | Organization |
| Organization Name | NOVANT MEDICAL GROUP, INC. |
| Other Organization Name | SOUTHEAST CHILDREN'S UROLOGY |
| Practice Address |
1401 Matthews Township Pkwy Suite 312 Matthews NC 28105-5402 |
| Mailing Address |
Po Box 60447 Charlotte NC 28260-0447 |
| Practice Telephone | 7043849530 |
| Practice Fax Number | 7043849535 |
| Mailing Telephone | 7043847840 |
| Mailing Fax Number | 7043847830 |
| Enumeration Date | 2010-06-04 |
| Last Update Date | 2010-06-04 |
| Authorized Official Name | MR. GEOFFREY GARDNER (VP OF FINANCE) |
| Authorized Official Telephone | 7043849094 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208800000X | Urology | Allopathic & Osteopathic Physicians | ||
| Y | 2088P0231X |
Urology Specialization: Pediatric Urology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Southeast Children's Urology | 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 |
1401 MATTHEWS TOWNSHIP PKWY SUITE 312 |
| City | MATTHEWS |
| State | NC |
| Zip Code | 28105-5402 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760471221 | Irving David Wight | Physician Assistant | 1401 Matthews Township Pkwy, Suite 101, Matthews, NC 28105-5402 | 2005-10-18 |
| 1023574191 | Tarah Faust | Physical Therapy Assistant | 1401 Matthews Township Pkwy, Matthews, NC 28105-5402 | 2019-02-14 |
| 1952842833 | Novant Medical Group, Inc | Psychiatry & Neurology | 1401 Matthews Township Pkwy, Suite 320, Matthews, NC 28105-5402 | 2017-03-13 |
| 1427596329 | Claudiu Samuel Mioc | Physician Assistant | 1401 Matthews Township Pkwy, Suite 380, Matthews, NC 28105-5402 | 2017-02-10 |
| 1942748538 | Chelsea Hopkins | Physician Assistant | 1401 Matthews Township Pkwy, Matthews, NC 28105-5402 | 2017-02-03 |
| 1326597493 | Novant Medical Group, Inc | Social Worker | 1401 Matthews Township Pkwy, Suite 320, Matthews, NC 28105-5402 | 2016-09-29 |
| 1174071229 | Donna C Knowlton Dds Pllc | Dentist | 1401 Matthews Township Pkwy, Ste 210, Matthews, NC 28105-5402 | 2016-09-19 |
| 1740645886 | Laboratory Corporation of America Holdings | Clinical Medical Laboratory | 1401 Matthews Township Pkwy, Suite 100, Matthews, NC 28105-5402 | 2015-12-16 |
| 1861861346 | Carolina Neurosurgery & Spine Associates, Pa | Neurological Surgery | 1401 Matthews Township Pkwy, Suite 300, Matthews, NC 28105-5402 | 2015-09-15 |
| 1194152512 | Novant Medical Group, Inc. | Pediatrics | 1401 Matthews Township Pkwy, Suite 100, Matthews, NC 28105-5403 | 2013-09-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750917407 | Lauren Deasy Blackshaw | Counselor | 1163 Sam Newell Rd, Matthews, NC 28105 | 2020-03-13 |
| 1912549643 | Monarch | Community/Behavioral Health | 10545 Paces Avenue 634, Matthews, NC 28105 | 2019-10-15 |
| 1326515768 | Holly Harvey Heddleson | Nurse Practitioner | 1450 Matthews Township Pkwy Ste 280, Matthews, NC 28105 | 2018-10-24 |
| 1396241030 | Erickson Health Medical Group of North Carolina, PC | Internal Medicine | 2030 Windsor Run Lane, Matthews, NC 28105 | 2018-04-02 |
| 1811406994 | Lice Clinics of America of The Carolinas | Technician, Other | 3042 Suite C Senna Dr, Matthews, NC 28105 | 2017-09-21 |
| 1376065003 | Carillon Assisted Living of Mint Hill, LLC | Custodial Care Facility | 5601 Margaret Wallace Road, Matthews, NC 28105 | 2017-07-14 |
| 1568906055 | London Young | Physical Therapy Assistant | 11100- 11189 Berkley Square Ln, Charlotte, NC 28105 | 2016-12-19 |
| 1003363128 | New Beginnings Community Counseling Center | Community/Behavioral Health | 5232 Maragaret Wallace Road, Matthews, NC 28105 | 2016-09-07 |
| 1275993149 | Kristi Dougan | Nurse Practitioner | 434 N Trade St Ste 104, Matthews, NC 28105 | 2016-03-04 |
| 1205219896 | Kalyani Vellanki Starr | Dentist | 1819 Matthews Township Pkwy Ste 200, Matthews, NC 28105 | 2015-07-01 |
| Find all providers in zip 28105 | ||||
| Taxonomy Code | 2088P0231X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| Specialization | Pediatric Urology |
| Surgeons who can diagnose, treat, and manage children’s urinary and genital problems. A pediatric urologist devotes a minimum of 50% of his or her practice to the urologic problems of infants, children, and adolescents. Pediatric urologists generally provide the following services: the evaluation and management of voiding disorders; vesicoureteral reflux, and urinary tract infections that require surgery; surgical reconstruction of the urinary tract (kidneys, ureters, and bladder) including genital abnormalities, hypospadias, and intersex conditions; surgery for groin conditions in childhood and adolescence (undescended testes, hydrocele/hernia, varicocele). |
| Notes: Source: American Academy of Pediatrics [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164678819 | Scott A. Berkman, Md, Plc | Urology | 17332 Newlands Corner Lane, Charlotte, NC 28277-1073 | 2008-08-13 |
| 1356880801 | Carolinas Physicians Network Inc | Urology | 1025 Morehead Medical Dr, Ste 275, Charlotte, NC 28204-2963 | 2017-02-16 |
| 1861715245 | Carolinas Physicians Network Inc | Urology | 101 E W T Harris Blvd, Suite 3301, Charlotte, NC 28262-3485 | 2010-03-12 |
| 1306169768 | Carolinas Physicians Network, Inc. | Urology | 9625 Northcross Center Ct, Suite 102, Huntersville, NC 28078-7348 | 2010-03-12 |
| 1780907220 | Carolinas Physicians Network Inc | Urology | 50 Hospital Dr, Suite 1c, Hendersonville, NC 28792-5248 | 2010-03-11 |
| 1114240652 | Carolinas Physicians Network, Inc. | Urology | 100 Medical Park Drive, Suite 310, Concord, NC 28025-2966 | 2010-03-11 |
| 1447573209 | Carolinas Physicians Network Inc | Urology | 1001 Blythe Blvd, Suite 200, Charlotte, NC 28203-5866 | 2010-03-09 |
| 1376866129 | Carolinas Physicians Network, Inc. | Urology | 1781 Tate Blvd Se, Hickory, NC 28602-4251 | 2010-03-09 |
| 1871713859 | Joseph A. Molitierno Jr. | Urology | 3125 Springbank Ln, Suite E, Charlotte, NC 28226-3379 | 2007-05-01 |
| 1952434672 | Carolinas Physicians Network, Inc. | Urology | 3125 Springbank Ln, Suite E, Charlotte, NC 28226-3378 | 2007-03-13 |
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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.