NOVANT MEDICAL GROUP, INC (NPI# 1043503287) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043503287 |
| Entity Type | Organization |
| Organization Name | NOVANT MEDICAL GROUP, INC |
| Other Organization Name | NOVANT HEALTH PSYCHIATRIC MEDICINE |
| Practice Address |
175 Kimel Park Dr Suite 100 Winston Salem NC 27103-6951 |
| Mailing Address |
Po Box 60447 Charlotte NC 28260-0447 |
| Practice Telephone | 3362771800 |
| Practice Fax Number | 3362779538 |
| Mailing Telephone | 7043847840 |
| Mailing Fax Number | 7043847830 |
| Enumeration Date | 2011-05-20 |
| Last Update Date | 2013-06-21 |
| Authorized Official Name | GEOFFREY K GARDNER (VP OF FINANCE) |
| Authorized Official Telephone | 7043849094 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 5917753 | 05 |
| Other Name | Type Code |
|---|---|
| Novant Health Psychiatric Medicine | 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 |
175 KIMEL PARK DR SUITE 100 |
| City | WINSTON SALEM |
| State | NC |
| Zip Code | 27103-6951 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174524979 | Michael L Pool | Psychiatry & Neurology | 175 Kimel Park Dr, Suite 100, Winston Salem, NC 27103-6951 | 2005-08-03 |
| 1497297584 | Christie Nelson | Counselor | 175 Kimel Park Dr, Suite 100, Winston Salem, NC 27103-6951 | 2016-11-07 |
| 1578959755 | Emily Hix Dothard | Dermatology | 175 Kimel Park Dr, Winston Salem, NC 27103-6951 | 2015-04-14 |
| 1245630128 | Cumi Bevel | Social Worker | 175 Kimel Park Dr, Suite 100, Winston Salem, NC 27103-6951 | 2014-08-28 |
| 1831524933 | Stewart Kepley Austin | Social Worker | 175 Kimel Park Dr, Suite 100, Winston Salem, NC 27103-6951 | 2013-09-08 |
| 1760752638 | Lashanda M King-jones | Counselor | 175 Kimel Park Dr, Suite 100, Winston Salem, NC 27103-6951 | 2012-01-09 |
| 1417271313 | Forsyth Memorial Hospital, Inc | Family Medicine | 175 Kimel Park Dr, Winston Salem, NC 27103-6951 | 2010-03-22 |
| 1093943599 | Jessica Cipoletti Derreberry | Psychiatry & Neurology | 175 Kimel Park Dr, Winston Salem, NC 27103-6951 | 2009-06-23 |
| 1346427200 | Forsyth Memorial Hospital Inc | Psychiatry & Neurology | 175 Kimel Park Dr, Suite 100, Winston Salem, NC 27103-6951 | 2008-01-23 |
| 1508046053 | Forsyth Medical Hospital, Inc | Dermatology | 175 Kimel Park Dr, Dba Winston-salem Healthcare, Winston Salem, NC 27103-6951 | 2007-11-13 |
| Find all providers in the same location | ||||
| 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 | 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 |
|---|---|---|---|---|
| 1811417835 | Arvind Muralimohan Gomadam | Psychiatry & Neurology | 1492 Rymco Dr, Winston Salem, NC 27103 | 2017-06-21 |
| 1760802474 | Michael Verenes | Psychiatry & Neurology | 2025 Frontis Plaza Blvd Ste 120, Winston Salem, NC 27103 | 2014-04-21 |
| 1245539212 | David Hosford | Psychiatry & Neurology | 200 E 1st St Ste 300, Winston Salem, NC 27101-4165 | 2011-03-16 |
| 1447334388 | Margaret Louise Craig | Psychiatry & Neurology | 1915 Cadman Forest Drive, Winston Salem, NC 27127-4684 | 2006-10-25 |
| 1841848249 | Novant Medical Group Inc | Psychiatry & Neurology | 190 Kimel Park Dr Ste 131, Winston Salem, NC 27103-6946 | 2019-08-28 |
| 1043713910 | Novant Medical Group, Inc. | Psychiatry & Neurology | 3333 Silas Creek Pkwy, Winston Salem, NC 27103-3013 | 2018-03-16 |
| 1134656143 | Novant Medical Group Inc | Psychiatry & Neurology | 190 Kimel Park Dr Ste 121, Winston Salem, NC 27103-6946 | 2017-05-22 |
| 1649655028 | Devanshi Dharaiya | Psychiatry & Neurology | 3333 Silas Creek Pkwy, Winston Salem, NC 27103 | 2015-07-27 |
| 1780063958 | Novant Medical Group, Inc. | Psychiatry & Neurology | 2025 Frontis Plaza Blvd, Suite 120, Winston Salem, NC 27103-5663 | 2015-05-21 |
| 1568857480 | Tamra Ishan Jayendra Ranasinghe | Psychiatry & Neurology | Medical Center Blvd, Winston Salem, NC 27157-9180 | 2015-03-30 |
| Find all providers in WINSTON SALEM | ||||
| City | WINSTON SALEM |
| Zip Code | 27103 |
Please comment or provide details below to improve the information on NOVANT MEDICAL GROUP, INC.
| 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.