NOVANT MEDICAL GROUP INC (NPI# 1255709432) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255709432 |
| Entity Type | Organization |
| Organization Name | NOVANT MEDICAL GROUP INC |
| Other Organization Name | NOVANT HEALTH FAMILY MEDICINE RESIDENCY CLINIC |
| Practice Address |
19485 Old Jetton Road Suite 100 Cornelius NC 28031-6583 |
| Mailing Address |
Po Box 60447 Charlotte NC 28260-0447 |
| Practice Telephone | 7043165170 |
| Practice Fax Number | 7043165172 |
| Mailing Telephone | 7043165170 |
| Mailing Fax Number | 7043165172 |
| Enumeration Date | 2015-09-04 |
| Last Update Date | 2015-09-04 |
| Authorized Official Name | GEOFFREY K GARDNER (VP FINANCE) |
| Authorized Official Telephone | 7043847603 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Novant Health Family Medicine Residency Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700433711 | Novant Medical Group Inc | Psychiatry & Neurology | 933 Rockford St Ste 2, Mount Airy, NC 27030-5323 | 2019-08-23 |
| 1205481009 | Novant Medical Group Inc | Dermatology | 6324 Fairview Rd # 200, Charlotte, NC 28210-3271 | 2019-08-08 |
| 1033675079 | Novant Medical Group Inc | Psychiatry & Neurology | 1918 Randolph Rd Ste 320, Charlotte, NC 28207-1109 | 2019-02-14 |
| 1205355799 | Novant Medical Group Inc | Family Medicine | 16525 Holly Crest Ln Ste 250, Huntersville, NC 28078-4912 | 2017-09-15 |
| 1679090468 | Novant Medical Group Inc | Internal Medicine | 12311 Copper Way Ste 100, Charlotte, NC 28277-3643 | 2017-08-23 |
| 1003332016 | Novant Medical Group Inc | Internal Medicine | 10030 Gilead Rd Ste 344, Huntersville, NC 28078-7545 | 2017-08-22 |
| 1215326665 | Novant Medical Group Inc | Surgery | 819 N Atlantic Ave, Southport, NC 28461-3531 | 2015-01-22 |
| 1194113662 | Novant Medical Group Inc | Obstetrics & Gynecology | 1730 Kernersville Medical Parkway, Suite 104, Kernersville, NC 27284-7198 | 2015-01-06 |
| 1437556594 | Novant Medical Group Inc | Internal Medicine | 13 Medical Campus, Suite 102, Supply, NC 28462-4093 | 2014-12-04 |
| 1063818979 | Novant Medical Group Inc | Advanced Practice Midwife | 106 Langtree Village Drive, Suite 200, Mooresville, NC 28117-7571 | 2014-11-05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| North Carolina Corporations | Novant Medical Group Inc. | 2626 Glenwood Ave Ste 550, Raleigh, NC 27608 |
| Virginia Business Entities | Novant Medical Group Inc. | 2085 Frontis Plaza Blvd, Winston Salem, North Carolina 27103 |
| Street Address |
19485 OLD JETTON ROAD SUITE 100 |
| City | CORNELIUS |
| State | NC |
| Zip Code | 28031-6583 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568998698 | Christine Wu | Student in an Organized Health Care Education/Training Program | 19485 Old Jetton Road, Novant Health Family Medicine Residency Clinic, Cornelius, NC 28031 | 2017-05-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144827221 | Jessica Leigh Akbari | Behavior Technician | 16915 Liverpool Pkwy. Suite B, Cornelius, NC 28031 | 2020-10-02 |
| 1548871569 | Aalasa Brooks | Behavior Technician | 16915 Liverpool Pkwy, Suite B, Cornelius, NC 28031 | 2020-08-13 |
| 1366053381 | Mary-clara Pearl Mcalister | Behavior Technician | 16915 Liverpool Parkway, Suite B, Cornelius, NC 28031 | 2020-08-13 |
| 1851926075 | Cherie Torrence | Acupuncturist | 16930 W. Catawba Ave 203, Cornelius, NC 28031 | 2020-03-09 |
| 1154970481 | 100 Percent Chiropractic Padilla, LLC | Chiropractor | 19722 One Norman Drive, Suite 210, Cornelius, NC 28031 | 2019-09-09 |
| 1528628526 | O'brien and West, Dmd Viii, Pllc | Dentist | 19911 Zion Ave Bldg D, Ste. #d4, Cornelius, NC 28031 | 2019-06-20 |
| 1548775182 | Gretchen Anthony | Social Worker | 17105 Kenton Drive, Suite 201c, Cornelius, NC 28031 | 2017-12-05 |
| 1669842076 | Harris Teeter LLC | Durable Medical Equipment & Medical Supplies | 21720 Catawba Ave, Cornelius, NC 28031 | 2015-09-28 |
| 1518336296 | Special Touch Living | Clinic/Center | 11262 Heritage Green Drive, Cornelius, NC 28031 | 2015-09-23 |
| 1568830917 | Michelle Rene Skaggs | Occupational Therapist | 9075 Rosalyn Glen Rd, Cornelius, NC 28031 | 2015-09-02 |
| Find all providers in zip 28031 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134481377 | Amanda Evelyn White | Family Medicine | 19485 Old Jetton Rd Ste 200, Cornelius, NC 28031 | 2012-06-13 |
| 1154587103 | Carolinas Physicians Network, Inc. | Family Medicine | 9606 Caldwell Commons Cir, Ste B, Cornelius, NC 28031-8111 | 2008-07-30 |
| 1700060092 | Mario Augusto Hernandez | Family Medicine | 18509 Statesville Rd Ste B1, Cornelius, NC 28031-5703 | 2007-12-21 |
| 1427186022 | Heather Michelle Manos | Family Medicine | 19485 Old Jetton Rd Ste 270, Cornelius, NC 28031-6592 | 2007-03-02 |
| 1053367540 | Laura R. Byerly | Family Medicine | 1151 N. Adair St., Cornelius, OR 97113 | 2006-05-26 |
| 1578523874 | Phuong M Nguyen | Family Medicine | 19830 Zion Ave, Cornelius, NC 28031-1783 | 2006-03-23 |
| 1679552822 | Lee B Lindquist | Family Medicine | 19485 Old Jetton Rd Ste 100, Cornelius, NC 28031-6583 | 2006-01-15 |
| 1619599172 | Renew Health and Wellness | Family Medicine | 19824 W Catawba Ave Ste E, Cornelius, NC 28031-4046 | 2020-05-07 |
| 1871122184 | Carley Borrelli | Family Medicine | 19475 Old Jetton Rd Ste 200, Cornelius, NC 28031-6591 | 2020-04-07 |
| 1336778455 | Rebecca Groch | Family Medicine | 19485 Old Jetton Rd, Cornelius, NC 28031-6582 | 2020-04-02 |
| Find all providers in CORNELIUS | ||||
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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.