NOVANT MEDICAL GROUP INC (NPI# 1376976043) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376976043 |
| Entity Type | Organization |
| Organization Name | NOVANT MEDICAL GROUP INC |
| Other Organization Name | NOVANT HEALTH TRIAD SURGICAL ASSOCIATES |
| Practice Address |
1900 S Hawthorne Rd Suite 480 Winston Salem NC 27103-3913 |
| Mailing Address |
Po Box 60447 Charlotte NC 28260-0447 |
| Practice Telephone | 3367650155 |
| Practice Fax Number | 3367655494 |
| Mailing Telephone | 7043847840 |
| Enumeration Date | 2013-08-16 |
| Last Update Date | 2014-05-01 |
| Authorized Official Name | MR. GEOFFREY K GARDNER (VP FINANCE) |
| Authorized Official Telephone | 3367650155 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 1376976043 | 05 |
| Other Name | Type Code |
|---|---|
| Novant Health Triad Surgical Associates | 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 |
| 1255709432 | Novant Medical Group Inc | Family Medicine | 19485 Old Jetton Road, Suite 100, Cornelius, NC 28031-6583 | 2015-09-04 |
| 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 |
| 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 |
1900 S HAWTHORNE RD SUITE 480 |
| City | WINSTON SALEM |
| State | NC |
| Zip Code | 27103-3913 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760483689 | Thomas Paul Mutton | Specialist | 1900 S Hawthorne Rd, Suite 480, Winston Salem, NC 27103-3913 | 2005-08-02 |
| 1730564691 | Mary Lomberk | Pharmacist | 1900 S Hawthorne Rd, Suite 504, Winston Salem, NC 27103-3913 | 2015-07-21 |
| 1861870198 | Janelle Fitzjohn | Dietitian, Registered | 1900 S Hawthorne Rd, Suite 170, Winston Salem, NC 27103-3913 | 2015-05-06 |
| 1447672639 | Jennifer Bailiff | Dietitian, Registered | 1900 S Hawthorne Rd, Suite 170, Winston Salem, NC 27103-3913 | 2014-01-08 |
| 1669806477 | Alice Christine Smith | Dietitian, Registered | 1900 S Hawthorne Rd, Suite 170, Winston Salem, NC 27103-3913 | 2013-08-28 |
| 1902195761 | Community Care Center | Voluntary or Charitable | 1900 S Hawthorne Rd, Suite 564, Winston Salem, NC 27103-3913 | 2011-04-01 |
| 1033418710 | Delip Vikram Patel | Radiology | 1900 S Hawthorne Rd, Winston Salem, NC 27103-3913 | 2011-03-21 |
| 1720228158 | Novant Medical Group Inc | Internal Medicine | 1900 S Hawthorne Rd, Suite 652, Winston Salem, NC 27103-3901 | 2009-02-25 |
| 1881841856 | Cutaneous Pathology, P.a. | Pathology | 1900 S Hawthorne Rd, Suite 366, Winston Salem, NC 27103-3913 | 2008-08-21 |
| 1740447465 | Edward G. Burnett Jr. D.d.s.,p.a. | Clinic/Center | 1900 S Hawthorne Rd, Ste 552, Winston Salem, NC 27103-3913 | 2008-05-20 |
| 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 | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386128601 | Venkateswara Rao Gurram | Surgery | 5075 Winster Dr Apt 202, Winston Salem, NC 27106-2988 | 2018-09-21 |
| 1376981217 | Kathryn Starr Sobba | Surgery | Wake Forest Baptist Health General Surgery, Medical Center Boulevard, Winston Salem, NC 27157-0001 | 2013-06-13 |
| 1548550544 | David Johnson Hiller | Surgery | 2825 Lyndhurst Ave Ste 101, Winston Salem, NC 27103-4146 | 2011-04-11 |
| 1144481029 | Baogang Liu | Surgery | Medical Central Blvd, Winston Salem, NC 27157-0001 | 2008-06-23 |
| 1699955427 | Joel Krishna Deonanan | Surgery | 2827 Lyndhurst Ave Ste 203, Winston Salem, NC 27103-4145 | 2007-11-08 |
| 1720094352 | Earll Parks Welch | Surgery | 2850 Merry Acres Ln, Winston Salem, NC 27106-5743 | 2006-08-01 |
| 1114984267 | George William Haggerson | Surgery | 3318 Healy Dr, Winston Salem, NC 27103-1404 | 2006-05-01 |
| 1437119302 | Stanley B. Fuller | Surgery | 2825 Lyndhurst Ave, Ste 101, Winston Salem, NC 27103-4146 | 2006-03-24 |
| 1164481685 | Claude Raymond Workman | Surgery | 2827 Lyndhurst Ave, Suite 203, Winston Salem, NC 27103-4145 | 2006-03-22 |
| 1578044558 | Sue Adkins Fitzko | Surgery | 1 Medical Center Boulevard, Winston Salem, NC 27157 | 2018-08-27 |
| 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.