NOVANT MEDICAL GROUP, INC. (NPI# 1578057394) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578057394 |
| Entity Type | Organization |
| Organization Name | NOVANT MEDICAL GROUP, INC. |
| Other Organization Name | NOVANT HEALTH PEDIATRICS LAKE NORMAN |
| Practice Address |
656 Carpenter Ave Mooresville NC 28115-2538 |
| Mailing Address |
Po Box 60447 Charlotte NC 28260-0447 |
| Practice Telephone | 7046645133 |
| Practice Fax Number | 7046600406 |
| Mailing Telephone | 8442668268 |
| Enumeration Date | 2018-06-15 |
| Last Update Date | 2018-06-15 |
| Authorized Official Name | SHALA DAVIS (MANAGER) |
| Authorized Official Telephone | 7043167845 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Novant Health Pediatrics Lake Norman | 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 |
656 CARPENTER AVE |
| City | MOORESVILLE |
| State | NC |
| Zip Code | 28115-2538 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083698005 | Gianna Demos Madrid | Pediatrics | 656 Carpenter Ave, Mooresville, NC 28115-2538 | 2005-12-02 |
| 1790049641 | Kevin David Wellbaum | Pediatrics | 656 Carpenter Ave, Mooresville, NC 28115-2538 | 2012-06-26 |
| 1427015254 | Lake Norman Pediatrics, Pa | Pediatrics | 656 Carpenter Ave, Mooresville, NC 28115-2538 | 2006-04-26 |
| 1336124924 | Karen S Mayhew | Pediatrics | 656 Carpenter Ave, Mooresville, NC 28115-2538 | 2005-12-07 |
| 1215912803 | Laura O'donnell | Pediatrics | 656 Carpenter Ave, Mooresville, NC 28115-2538 | 2005-12-07 |
| 1912982505 | Robin C Ray | Pediatrics | 656 Carpenter Ave, Mooresville, NC 28115-2538 | 2005-12-07 |
| 1962486043 | Avani Mahendra Doshi | Pediatrics | 656 Carpenter Ave, Mooresville, NC 28115-2538 | 2005-12-02 |
| 1154305134 | Amy Poteat Ferguson | Pediatrics | 656 Carpenter Ave, Mooresville, NC 28115-2538 | 2005-12-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376172338 | Shawn Booth | Counselor | 111 Laporte Lane, Mooresville, NC 28115 | 2020-04-02 |
| 1407418262 | Carlyn Jean Malenfant | Dentist | Loveland Dental Group of Mooresville, 134 N. Magnolia Street, Mooresville, NC 28115 | 2019-07-02 |
| 1619435906 | Loveland Dental Group of Mooresville | Dentist | 134 N. Magnolia Street, Mooresville, NC 28115 | 2019-03-06 |
| 1801317383 | Jessie Watts Gogg | Social Worker | 138 Shepherd Rd, Mooresville, NC 28115 | 2017-07-05 |
| 1063869469 | Amber Hicks-thibodeau | Family Medicine | 798 Oak Ridge Farm Hwy. Suite A, Mooresville, NC 28115 | 2016-05-16 |
| 1003286774 | Lauren Holscher | Speech-Language Pathologist | 3369 Deal Rd, Mooresville, NC 28115 | 2015-10-06 |
| 1629460217 | Jenny S Ryerson | Social Worker | 919 N Main St Ste B, Mooresville, NC 28115 | 2015-02-19 |
| 1720495435 | Lindsey Gardner | Pharmacist | 966 E Iredell Ave., Mooresville, NC 28115 | 2014-07-14 |
| 1568899169 | Saloni Mehta | Physical Therapist | 550 Glenwood Drive, Genesis Rehab, Charlotte, NC 28115 | 2013-09-27 |
| 1528312600 | Ronnie G. Davidson II Dmd Pa | Dentist | 134 N. Magnolia St., Mooresville, NC 28115 | 2012-10-29 |
| Find all providers in zip 28115 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| 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 Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649624529 | Corin Marshall | Pediatrics | 1001 Hadley Rd Ste Ll050, Mooresville, IN 46158-1883 | 2016-04-18 |
| 1235347378 | Northlake Children's Associates, P.a. | Pediatrics | 170a Medical Park Rd, Suite 102, Mooresville, NC 28117 | 2007-05-21 |
| 1083783245 | Stephen J Malloney | Pediatrics | 134 Medical Park Rd Ste 100, Mooresville, NC 28117-8527 | 2006-11-06 |
| 1356357727 | Mooresville Hma Physician Management, Inc. | Pediatrics | 207 S Broad St, Ste 5, Mooresville, NC 28115-3500 | 2006-07-31 |
| 1457396707 | Sidney L Gilbert | Pediatrics | 100 Town Center Drive, Suite B, Mooresville, IN 46158 | 2006-06-19 |
| 1073566014 | Elizabeth Ellen Tilt | Pediatrics | 136 Gateway Blvd Ste A, Mooresville, NC 28117-5608 | 2006-05-19 |
| 1104891902 | Shelley H. Rinker | Pediatrics | 133 Welton Way, Suite C, Mooresville, NC 28117 | 2006-02-23 |
| 1083698005 | Gianna Demos Madrid | Pediatrics | 656 Carpenter Ave, Mooresville, NC 28115-2538 | 2005-12-02 |
| 1275006835 | Piedmont Healthcare, Pa | Pediatrics | 128 Medical Park Rd Ste 200, Mooresville, NC 28117-8579 | 2019-01-07 |
| 1790049641 | Kevin David Wellbaum | Pediatrics | 656 Carpenter Ave, Mooresville, NC 28115-2538 | 2012-06-26 |
| Find all providers in MOORESVILLE | ||||
| City | MOORESVILLE |
| Zip Code | 28115 |
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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.