NOVANT MEDICAL GROUP, INC (NPI# 1083986111) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083986111 |
| Entity Type | Organization |
| Organization Name | NOVANT MEDICAL GROUP, INC |
| Other Organization Name | NOVANT HEALTH TRIAD OBSTETRICS & GYNECOLOGY |
| Practice Address |
2909 Maplewood Avenue Winston Salem NC 27103 |
| Mailing Address |
Po Box 60447 Charlotte NC 28260-0447 |
| Practice Telephone | 3362770340 |
| Practice Fax Number | 3362770359 |
| Mailing Telephone | 3362770340 |
| Mailing Fax Number | 3362770359 |
| Enumeration Date | 2012-02-06 |
| Last Update Date | 2014-09-19 |
| Authorized Official Name | GEOFFREY K GARDNER (VP OF FINANCE) |
| Authorized Official Telephone | 3362770340 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 1083986111 | 05 | |
| NC | FORMER NC MEDICAID NUMBER | 5919510 | 01 |
| Other Name | Type Code |
|---|---|
| Novant Health Triad Obstetrics & Gynecology | 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 |
2909 MAPLEWOOD AVENUE |
| City | WINSTON SALEM |
| State | NC |
| Zip Code | 27103 |
| 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 | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518353689 | Nicholas Roth Schoenbachler | Obstetrics & Gynecology | 111 Hanestown Ct # 151, Winston Salem, NC 27103 | 2015-04-15 |
| 1750788659 | Novant Medical Group Inc. | Obstetrics & Gynecology | 301 Executive Park Blvd, Winston Salem, NC 27103-1505 | 2014-11-21 |
| 1932528833 | Zineb Mashak | Obstetrics & Gynecology | 1 Medical Center Blvd Obgyn Department, Winston Salem, NC 27157 | 2014-04-08 |
| 1306274394 | Robert Paul Zammit | Obstetrics & Gynecology | 3624 Wickersham Ln, Winston Salem, NC 27106-3583 | 2013-10-29 |
| 1427315779 | Tristan Gonzalez-sanz | Obstetrics & Gynecology | 115 Hanestown Ct, Suite 151, Winston Salem, NC 27103 | 2012-04-11 |
| 1427230291 | Ray M Braquet | Obstetrics & Gynecology | 1806 South Hawthorne Road, Winston Salem, NC 27103 | 2007-12-03 |
| 1639288343 | Jonathan D Weston | Obstetrics & Gynecology | 495 N Cleveland Ave, Winston Salem, NC 27101-4334 | 2006-08-29 |
| 1053352435 | Douglas Wayne Miyazaki | Obstetrics & Gynecology | 770 Highland Oaks Dr Ste 100, Winston Salem, NC 27103-7105 | 2006-06-09 |
| 1821047846 | Michael J Pollak | Obstetrics & Gynecology | 941 Bryans Place Rd, Winston Salem, NC 27104-5007 | 2006-05-08 |
| 1043283211 | Laura Best Ramsay | Obstetrics & Gynecology | 114 Charlois Blvd, Winston Salem, NC 27103-1522 | 2006-02-08 |
| 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.