NOVANT MEDICAL GROUP, INC. (NPI# 1134383870) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134383870 |
| Entity Type | Organization |
| Organization Name | NOVANT MEDICAL GROUP, INC. |
| Other Organization Name | STATESVILLE UROLOGY |
| Practice Address |
1410 Fern Creek Drive Statesville NC 28625-4483 |
| Mailing Address |
Po Box 60447 Charlotte NC 28260-0447 |
| Practice Telephone | 7048736065 |
| Practice Fax Number | 7048736058 |
| Mailing Telephone | 7048736065 |
| Mailing Fax Number | 7048736058 |
| Enumeration Date | 2008-07-11 |
| Last Update Date | 2008-09-11 |
| Authorized Official Name | DINESH S PAI (VP OF OPERATIONS) |
| Authorized Official Telephone | 7043849113 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | NC | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Statesville 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 |
1410 FERN CREEK DRIVE |
| City | STATESVILLE |
| State | NC |
| Zip Code | 28625-4483 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730714163 | Sandra Lourdes Mayta | Counselor | 1450 Fern Creek Drive, Statesville, NC 28625 | 2020-03-05 |
| 1023643582 | Youngchi Chang Dds Pllc | Dentist | 964 Glenway Ave Ste A, Statesville, NC 28625 | 2020-03-05 |
| 1538799200 | Nicole-marie Blischak | Dentist | 964 Glenway Dr, Ste A, Statesville, NC 28625 | 2020-01-22 |
| 1013575257 | Sherry Neilson | Registered Nurse | 524 Signal Hill Rd, Statesville, NC 28625 | 2019-06-03 |
| 1770904328 | Elinor Kyle Tyner | Counselor | 1206 Museum Road, Statesville, NC 28625 | 2013-12-30 |
| 1982031001 | Tamiko Bradley | Counselor | 524 Signal Hill Dr Ext, Statesville, NC 28625 | 2013-10-03 |
| 1487932505 | Nicole Weisner Winecoff | Advanced Practice Midwife | 1420 Fern Creek Drive, Statesville, NC 28625 | 2011-07-22 |
| 1538461967 | Bethany J Sprague | Nurse Practitioner | 2632 Fines Creek Dr, Statesville, NC 28625 | 2010-11-17 |
| 1477789147 | Greenbriar Primary Care, Pa | Nurse Practitioner | 308-c Mocksville Highway, Statesville, NC 28625 | 2009-06-08 |
| 1619122538 | Phasebdevelopment | Substance Abuse Rehabilitation Facility | 113 Bethany Rd, Statesville, NC 28625 | 2008-11-19 |
| Find all providers in zip 28625 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508858390 | Carolyn M Coryell | Urology | 730 Hartness Rd, Statesville, NC 28677-3425 | 2005-08-17 |
| 1932476298 | Statesville Hma Medical Group, LLC | Urology | 1410 Fern Creek Dr, Statesville, NC 28625-9376 | 2011-11-30 |
| 1013291442 | Statesville Hma Medical Group, LLC | Urology | 1424 Fern Creek Dr, Suite B, Statesville, NC 28625-9376 | 2011-10-04 |
| 1497912018 | Kush Patel | Urology | 208 Old Mocksville Rd, Statesville, NC 28625-1953 | 2008-05-21 |
| 1922086966 | Michael H Schlesinger | Urology | 730 Hartness Rd, Statesville, NC 28677-3425 | 2006-01-09 |
| 1235121740 | Robert S Grajewski | Urology | 1424 Fern Creek Dr, Suite B, Statesville, NC 28625-9376 | 2005-08-19 |
| 1376535823 | Tink A Johnson IIi | Urology | 208 Old Mocksville Rd, Statesville, NC 28625-1930 | 2005-08-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528673423 | Meredith Abernethy | Urology | 140 Kimel Park Dr # 100, Winston Salem, NC 27103-6184 | 2020-09-09 |
| 1942833678 | Joshua Daniel Howell | Urology | 10650 Park Rd Ste 320, Charlotte, NC 28210-8543 | 2020-02-21 |
| 1144887019 | Shuo Liu | Urology | Department of Urology Medical Center Boulevard, Winston Salem, NC 27157-0001 | 2019-05-25 |
| 1427563725 | Hifu Prostate Services, LLC | Urology | 4108 Park Rd Ste 205, Charlotte, NC 28209-2260 | 2017-12-08 |
| 1134644859 | Ilan Binyamin Klein | Urology | Wake Forest Baptist Health, Department of Urology, Medical Center Boulevard, Winston-salem, NC 27157 | 2017-08-03 |
| 1184163883 | Dlp Central Carolina Medical Group LLC | Urology | 1139 Carthage St Ste 110-b, Sanford, NC 27330-4111 | 2017-02-15 |
| 1578007225 | Cumberland County Hospital System Inc | Urology | 805 Tilghman Dr, Suite A, Dunn, NC 28334-5887 | 2016-12-15 |
| 1063963080 | Novant Medical Group, Inc | Urology | 1730 Kernersville Medical Pkwy Ste 303, Kernersville, NC 27284-7198 | 2016-10-14 |
| 1588019152 | Murphy Medical Center, Inc. | Urology | 75 Medical Park Ln Ste A, Murphy, NC 28906-6673 | 2016-05-02 |
| 1427446723 | Regional Physicians LLC | Urology | 217- 218 Gatewood Ave, High Point, NC 27262-4877 | 2015-01-08 |
| Find all providers with the same taxonomy | ||||
| City | STATESVILLE |
| Zip Code | 28625 |
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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.