NOVANT MEDICAL GROUP, INC. (NPI# 1821525239) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821525239 |
| Entity Type | Organization |
| Organization Name | NOVANT MEDICAL GROUP, INC. |
| Other Organization Name | NOVANT HEALTH CAROLINA SURGICAL |
| Practice Address |
2104 Randolph Rd Charlotte NC 28207-1522 |
| Mailing Address |
Po Box 60447 Charlotte NC 28260-0447 |
| Practice Telephone | 7043773900 |
| Practice Fax Number | 7043771244 |
| Mailing Telephone | 7043773900 |
| Mailing Fax Number | 7043771244 |
| Enumeration Date | 2017-05-16 |
| Last Update Date | 2017-05-16 |
| Authorized Official Name | GEOFFREY K GARDNER (VP FINANCE) |
| Authorized Official Telephone | 7043773900 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Novant Health Carolina Surgical | 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 |
2104 RANDOLPH RD |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28207-1522 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710999628 | Ilan D Avin | Surgery | 2104 Randolph Rd, Charlotte, NC 28207 | 2006-08-12 |
| 1356852446 | Michael Andrianos Thomopoulos | Physician Assistant | 2104 Randolph Rd, Charlotte, NC 28207-1522 | 2017-10-17 |
| 1578072989 | Carter Martens | Surgery | 2104 Randolph Rd, Charlotte, NC 28207-1522 | 2017-09-28 |
| 1588185094 | Victoria Levesque | Dietitian, Registered | 2104 Randolph Rd, Charlotte, NC 28207-1522 | 2017-07-06 |
| 1346607827 | Lauren Taylor Sandberg | Physician Assistant | 2104 Randolph Rd, Charlotte, NC 28207-1522 | 2016-01-28 |
| 1952776825 | Sarah Klecha Ingold | Physician Assistant | 2104 Randolph Rd, Charlotte, NC 28207-1522 | 2015-12-03 |
| 1588060412 | Jessica Fowler Michalak | Physician Assistant | 2104 Randolph Rd, Charlotte, NC 28207-1522 | 2014-11-04 |
| 1851612089 | Nicholas Latchana | Surgery | 2104 Randolph Rd, Charlotte, NC 28207 | 2010-06-22 |
| 1245338557 | Carolina Surgical Clinic of Charlotte, Pa | Surgery | 2104 Randolph Rd, Charlotte, NC 28207-1522 | 2006-09-20 |
| 1417055716 | Carl Jarrett Lowe Jr. | Surgery | 2104 Randolph Rd, Charlotte, NC 28207-1522 | 2006-09-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013560739 | Louis Roncaglione | Dentist | 8815 Christenbury Pkway, Concord, NC 28207 | 2019-07-22 |
| 1619430014 | Khrystyna Levytska | Student in an Organized Health Care Education/Training Program | Myers Park Clinic Ob/gyn, 1350 S. Kings Dr., Charlotte, NC 28207 | 2019-04-11 |
| 1649743584 | Carolinas Hometown Respiratory LLC | Durable Medical Equipment & Medical Supplies | 1005 South Kings Drive, Charlotte, NC 28207 | 2019-01-03 |
| 1023584489 | Herron and Smith Associates, Pllc | Dentist | 135 Perrin Place, Suite 100, Charlotte, NC 28207 | 2018-10-23 |
| 1588161640 | Lauren Mogk | Student in an Organized Health Care Education/Training Program | Myers Park Clinical Internal Medicine, 1350 S. Kings Dr., 3rd Floor, Charlotte, NC 28207 | 2018-04-06 |
| 1518462241 | Sarah Hollyn Carlock | Student in an Organized Health Care Education/Training Program | Myers Park Clinic Internal Medicine, 1350 S Kings Dr, 3rd Floor, Charlotte, NC 28207 | 2018-03-26 |
| 1083118178 | Claire Milam | Student in an Organized Health Care Education/Training Program | Cmc/department of Emergency Medicine, 100 Blythe Blvd, Charlotte, NC 28207 | 2018-03-22 |
| 1811422256 | Complete Care At Dartmouth LLC | Skilled Nursing Facility | 300 Province Road, Charlotte, NC 28207 | 2017-04-24 |
| 1063945467 | Kaitlyn O'keefe | Internal Medicine | 1350 S. Kings Dr., 3rd Floor, Myers Park Clinic Internal Medicine, Charlotte, NC 28207 | 2017-04-04 |
| 1811432024 | Advanced Prosthetics of Easley, Inc | Durable Medical Equipment & Medical Supplies | 2310 Randolph Rd Ste A, Charlotte, NC 28207 | 2016-12-23 |
| Find all providers in zip 28207 | ||||
| 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 |
|---|---|---|---|---|
| 1922645571 | Novant Medical Group, Inc. | Surgery | 6324 Fairview Rd Ste 420, Charlotte, NC 28210-3372 | 2019-12-03 |
| 1154806271 | The Cosmetic Concierge, Pllc | Surgery | 325 Arlington Ave Unit B, Charlotte, NC 28203-4574 | 2018-09-25 |
| 1619363538 | William Charles Sherrill IIi | Surgery | 1000 Blythe Blvd Ste 601, Charlotte, NC 28203-5812 | 2015-04-07 |
| 1174968069 | Jonathan Bouchez | Surgery | 1000 Blythe Bvld., Charlotte, NC 28203 | 2013-05-06 |
| 1437475779 | Blair A Wormer | Surgery | 1901 Brunswick Ave Ste 200, Charlotte, NC 28207-1897 | 2010-04-12 |
| 1407039845 | Charles Arthur Hill IIi | Surgery | 325 Hawthorne Ln Ste 100, Charlotte, NC 28204 | 2007-12-07 |
| 1841491370 | Johnnie Lyles | Surgery | 2908 Oak Lake Blvd, Suite 205, Charlotte, NC 28208-7703 | 2007-05-31 |
| 1619000486 | Gordon W Jacobs | Surgery | 14920 Wyndham Oaks Dr, Charlotte, NC 28277-1512 | 2007-03-13 |
| 1750421228 | Sandra Giller | Surgery | 1918 Randolph Rd Ste 130, Charlotte, NC 28207-1107 | 2007-02-07 |
| 1831255009 | Wendell Aubrey Goins | Surgery | 9336 Blakeney Centre Dr, Ste 100b, Charlotte, NC 28277-6666 | 2006-12-29 |
| Find all providers in CHARLOTTE | ||||
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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.