NOVANT MEDICAL GROUP, INC (NPI# 1962957555) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962957555 |
| Entity Type | Organization |
| Organization Name | NOVANT MEDICAL GROUP, INC |
| Other Organization Name | NOVANT HEALTH NEUROLOGY AND SLEEP |
| Practice Address |
11840 Southmore Dr Suite 201 Charlotte NC 28277-4466 |
| Mailing Address |
Po Box 60447 Charlotte NC 28260-0447 |
| Practice Telephone | 7043169001 |
| Practice Fax Number | 7043169008 |
| Mailing Telephone | 7043169001 |
| Mailing Fax Number | 7043169008 |
| Enumeration Date | 2016-08-24 |
| Last Update Date | 2018-01-18 |
| Authorized Official Name | GEOFFREY K GARDNER (VP OF FINANCE) |
| Authorized Official Telephone | 7043169001 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Novant Health Neurology and Sleep | 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 |
11840 SOUTHMORE DR SUITE 201 |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28277-4466 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255315529 | Kristin Michelle Hietbrink | Physical Therapist | 11840 Southmore Dr, Suite 100, Charlotte, NC 28277-4466 | 2005-12-01 |
| 1013453604 | Novant Medical Group, Inc. | Pediatrics | 11840 Southmore Dr, Suite 200, Charlotte, NC 28277-4466 | 2017-01-06 |
| 1700236023 | G Abrams & R Cohen Xv PC | Dentist | 11840 Southmore Dr, Suite 150, Charlotte, NC 28277-4466 | 2016-06-17 |
| 1013386895 | Carolina Medicorp Enterprises, Inc | Family Medicine | 11840 Southmore Dr, Suite 100, Charlotte, NC 28277-4466 | 2015-09-22 |
| 1083015028 | Novant Medical Group, Inc | Internal Medicine | 11840 Southmore Dr, Suite 201, Charlotte, NC 28277-4466 | 2014-09-09 |
| 1063766848 | Omolara Layeni | Physician Assistant | 11840 Southmore Dr, Suite 100, Charlotte, NC 28277 | 2012-11-01 |
| 1043566680 | Molly Elizabeth Capella | Physical Therapist | 11840 Southmore Dr, Suite 100, Charlotte, NC 28277-4466 | 2012-08-01 |
| 1235401035 | Eric R Ford | Physical Therapist | 11840 Southmore Dr, Suite 100, Charlotte, NC 28277-4466 | 2012-02-08 |
| 1992091466 | Daryl Palmer | Physical Therapist | 11840 Southmore Dr, Suite 100, Charlotte, NC 28277-4466 | 2011-06-23 |
| 1649596768 | Michael A. Rosenberg | Physical Therapist | 11840 Southmore Dr, Suite 100, Charlotte, NC 28277-4466 | 2010-04-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255949731 | New Life Peer Support and Coaching LLC | Clinic/Center | 3450 Toringdon Way, Suite 200, Charlotte, NC 28277 | 2020-07-21 |
| 1083256762 | Speak Life Counseling Services, Pllc | Counselor | 16147 Lacaster Hwy, Suite 110, Charlotte, NC 28277 | 2019-10-14 |
| 1275010019 | Jigneshkumar R Mistry | Pharmacist | 11805 Allforth Ln Apt 2105, Charlotte, NC 28277 | 2018-07-24 |
| 1255825410 | Novant Medical Group Inc. | Family Medicine | 15033 Balloncroft Parkway, Suite 200, Charlotte, NC 28277 | 2018-06-20 |
| 1447752316 | Harris Teeter LLC | Durable Medical Equipment & Medical Supplies | 11135 Golf Links Dr, Charlotte, NC 28277 | 2018-03-06 |
| 1932607595 | Charlotte Proactive Md PC | Clinic/Center | 11220 Golf Links Drive North, Charlotte, NC 28277 | 2018-01-30 |
| 1003331521 | Accela Spine and Pain, Pllc | Anesthesiology | 10120 Ivey Chase Lane, Apt 617, Charlotte, NC 28277 | 2017-08-04 |
| 1265961619 | Dominicka Whitaker | Counselor | 12365 Bluestem Ln., Charlotte, NC 28277 | 2017-06-08 |
| 1083143408 | Monika D Hayes | Counselor | 11330 Snapfinger Drive, Charlotte, NC 28277 | 2017-06-08 |
| 1225582984 | Danielle Mcdaniel | Occupational Therapist | 5113 Piper Station Dr Ste 103, Charlotte, NC 28277 | 2016-08-11 |
| Find all providers in zip 28277 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578056057 | Novant Medical Group, Inc. | Psychiatry & Neurology | 15033 Ballancroft Pkwy Ste 200, Charlotte, NC 28277-4944 | 2018-06-11 |
| 1477992063 | Neil Ghanshyam Patel | Psychiatry & Neurology | 2801 Randolph Rd Ste 101, Charlotte, NC 28211-1051 | 2013-06-18 |
| 1437444346 | Megan Tudor Donnelly | Psychiatry & Neurology | 2801 Randolph Road Suite 101, Charlotte, NC 28211 | 2011-06-20 |
| 1992983589 | Sheela Myers | Psychiatry & Neurology | 10660 Park Road, Suite 4400, Charlotte, NC 28210 | 2008-02-05 |
| 1720161011 | Michael M Amiri | Psychiatry & Neurology | 1300 Baxter St Ste 114, Charlotte, NC 28204-3806 | 2006-10-23 |
| 1144321373 | Henry Joseph Horacek Jr. | Psychiatry & Neurology | 10716 Carmel Commons Blvd, Suite 120, Charlotte, NC 28226-3783 | 2006-09-26 |
| 1659322691 | Mohammad R. Bolouri | Psychiatry & Neurology | 7809 Sardis Rd, Charlotte, NC 28270-2757 | 2006-05-15 |
| 1013968858 | Richard David Jacobson | Psychiatry & Neurology | 4228 Brookfield Dr, Charlotte, NC 28210 | 2006-05-15 |
| 1306896592 | Kenneth Todd Ashkin | Psychiatry & Neurology | 8045 Providence Rd Ste 200, Charlotte, NC 28277-9724 | 2006-05-11 |
| 1336199587 | Thor Erik Borresen | Psychiatry & Neurology | 1900 Scott Ave, Charlotte, NC 28203-6046 | 2006-05-10 |
| 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.