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NOVANT HEALTH PEDIATRIC GASTROENTEROLOGY
NPI 1013453604
Pediatrics - Pediatric Gastroenterology in Charlotte, NC

Active since January 06, 2017CLIA Certified · 4 labs
11840 SOUTHMORE DR, SUITE 200, CHARLOTTE, NC 28277(704) 316-5060(704) 316-5069 Get Directions Write a Review

NPPES record last updated: August 16, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Aug 16, 2021, Jan 6, 2017 (2 updates tracked since 2017).

About Novant Health Pediatric Gastroenterology NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NOVANT HEALTH PEDIATRIC GASTROENTEROLOGY (NPI 1013453604) is a healthcare organization registered as a pediatric gastroenterology in Charlotte, North Carolina and active in the NPI registry since January 2017. The organization holds 4 active CLIA laboratory certificates and lists Shala Davis, Rcs Manager, as its authorized official.

NPPES Registry Identity

NPI1013453604
Entity TypeOrganization
Primary Taxonomy2080P0206X
Legal Business NameNOVANT MEDICAL GROUP, INC.
Location Address11840 SOUTHMORE DR, SUITE 200Charlotte, NC 28277-4466
Mailing AddressPo Box 60447Charlotte, NC 28260-0447 · (704) 316-5060 · Fax (704) 316-5069
Phone(704) 316-5060
Fax(704) 316-5069
Organization SubpartNo
Authorized OfficialShala DavisRcs Manager · (704) 303-7517
Enumeration DateJanuary 6, 2017
Last NPPES UpdateAugust 16, 20212 updates tracked since enumeration
NPPES CertifiedAugust 16, 2021
✔ NPI 1013453604 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatrics · Pediatric GastroenterologyAllopathic & Osteopathic Physicians
Taxonomy Code2080P0206X
Definition
A pediatrician who specializes in the diagnosis and treatment of diseases of the digestive systems of infants, children and adolescents. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using lighted scopes to see internal organs.
11840 SOUTHMORE DR, Charlotte, NC 28277
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Other Names 1

Doing Business AsNovant Health Pediatric Gastroenterology

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Novant Health Pediatric Gastroenterology is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2,991

Medicare enrollment records show 2,991 clinicians reassign Medicare billing to Novant Health Pediatric Gastroenterology, which bills Medicare for the services they deliver. Of these, 7 practice at this address and 397 within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 63

Nurse Practitioner759
Family Practice327
Hospitalist302
Pediatric Medicine233
Obstetrics/Gynecology187
Internal Medicine178
Neurology150
Cardiovascular Disease (Cardiology)94
55 other specialties761

Nearest to this location (20)

See all 2,991
Sumon Bhowmick, M.D.
Pediatric Medicine
NPI 1073704474
11840 SOUTHMORE DR STE 200
Charlotte, NC 28277
(704) 384-1166
✔ PECOSSame address
Brett Christoffersen, M.D.
Internal Medicine
NPI 1386617710
11840 SOUTHMORE DR SUITE 200
Charlotte, NC 28277
(704) 384-1166
✔ PECOS✔ Accepts MedicareSame address
Wiley Davis, M.D.
Family Practice
NPI 1558334284
11840 SOUTHMORE DR SUITE 200
Charlotte, NC 28277
(704) 384-1166
✔ PECOS✔ Accepts MedicareSame address
Catalina Delgra, M.D.
Pediatric Medicine
NPI 1942273370
11840 SOUTHMORE DR SUITE 200
Charlotte, NC 28277
(704) 384-1166
✔ PECOSSame address
Kimberly Lemaster, M.D.
Pediatric Medicine
NPI 1447223870
11840 SOUTHMORE DR SUITE 100
Charlotte, NC 28277
(704) 384-1166
✔ PECOS✔ Accepts MedicareSame address
Warsha Kumari Mandhan, MD
Internal Medicine
NPI 1104447366
11840 SOUTHMORE DR STE 200
Charlotte, NC 28277
(704) 384-1166
✔ PECOS✔ Accepts MedicareSame address
Anna Wood
Pediatric Medicine
NPI 1508493503
11840 SOUTHMORE DR STE 200
Charlotte, NC 28277
(704) 384-1166
✔ PECOSSame address
Kimberly Davis, MD
Pediatric Medicine
NPI 1760682546
8169 ARDREY KELL RD
Charlotte, NC 28277
(704) 542-5540
✔ PECOS1.6 mi
Sharrol Barnes, M.D.
Obstetrics/Gynecology
NPI 1609877091
5933 BLAKENEY PARK DR SUITE 100
Charlotte, NC 28277
(704) 316-2021
✔ PECOS✔ Accepts Medicare2.4 mi
Tina Hayes, CNM
Certified Nurse Midwife (CNM)
NPI 1427080357
5933 BLAKENEY PARK DR SUITE 100
Charlotte, NC 28277
(704) 316-2021
✔ PECOS2.4 mi
Sulekha Abukar, MD
Family Practice
NPI 1114468345
5815 BLAKENEY PARK DR STE 200B
Charlotte, NC 28277
(704) 316-5080
✔ PECOS✔ Accepts Medicare2.4 mi
Hans Kwaku, M.D.
Internal Medicine
NPI 1689630691
5815 BLAKENEY PARK DR STE 200B
Charlotte, NC 28277
(704) 316-5080
✔ PECOS✔ Accepts Medicare2.4 mi
Jenna Sykes, NP
Nurse Practitioner
NPI 1568985455
5815 BLAKENEY PARK DR STE 200B
Charlotte, NC 28277
(704) 316-5080
✔ PECOS✔ Accepts Medicare2.4 mi
Robert Giedraitis, MD
Physical Medicine and Rehabilitation
NPI 1396734190
7825 BALLANTYNE COMMONS PKWY STE 150
Charlotte, NC 28277
(704) 544-6920
✔ PECOS✔ Accepts Medicare2.6 mi
Andrew Marky
Neurosurgery
NPI 1679898548
7825 BALLANTYNE COMMONS PKWY STE 150
Charlotte, NC 28277
(704) 316-3070
✔ PECOS✔ Accepts Medicare2.6 mi
James Deering, M.D.
Interventional Pain Management
NPI 1043576051
7825 BALLANTYNE COMMONS PKWY STE 150
Charlotte, NC 28277
(704) 544-6920
✔ PECOS✔ Accepts Medicare2.6 mi
Tyrone Matthews, LCSW
Clinical Social Worker
NPI 1043533045
9929 REA RD STE 201
Waxhaw, NC 28173
(704) 316-1650
✔ PECOS✔ Accepts Medicare2.9 mi
Joseph Mcintosh, LCMHCA
Mental Health Counselor
NPI 1902532815
9929 REA RD STE 201
Waxhaw, NC 28173
(704) 316-1650
✔ PECOS✔ Accepts Medicare2.9 mi
Jessica Parker, M.D.
Neurology
NPI 1063702306
9929 REA RD
Waxhaw, NC 28173
(704) 316-1055
✔ PECOS✔ Accepts Medicare2.9 mi
Kris Ruangchotvit, M.D.
Psychiatry
NPI 1669854048
9929 REA RD STE 201
Waxhaw, NC 28173
(704) 316-1650
✔ PECOS✔ Accepts Medicare2.9 mi
See all 2,991 clinicians

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA 4

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 34D1067428

Novant Health Pediatric Gastroenterology · Charlotte, NC
Active · expires Apr 17, 2027
CLIA Number34D1067428
Laboratory TypePhysician Office
Certificate Effective DateApril 18, 2025
Certificate Expiration DateApril 17, 2027
Laboratory DirectorWilliam S. Houck
Laboratory Phone(704) 316-5060
Laboratory LocationNovant Health Pediatric Gastroenterology1918 Randolph Rd Suite 210, Charlotte, NC 28207
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 34D2280270

Novant Health Pediatric Gastroenterology - Matthew · Matthews, NC
Active · expires Feb 23, 2027
CLIA Number34D2280270
Laboratory TypePhysician Office
Certificate Effective DateFebruary 24, 2025
Certificate Expiration DateFebruary 23, 2027
Laboratory DirectorWilliam Houck
Laboratory Phone(704) 316-5060
Laboratory LocationNovant Health Pediatric Gastroenterology - Matthew1401 Matthews Township Pkwy, Suite 100, Matthews, NC 28105
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 34D2274347

Novant Health Pediatric Gastroenterology - Carmel · Charlotte, NC
Active · expires Jan 2, 2027
CLIA Number34D2274347
Laboratory TypePhysician Office
Certificate Effective DateJanuary 3, 2025
Certificate Expiration DateJanuary 2, 2027
Laboratory DirectorWilliam Houck
Laboratory Phone(704) 316-5060
Laboratory LocationNovant Health Pediatric Gastroenterology - Carmel6331 Carmel Road Suite 102, Charlotte, NC 28226
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 34D2274355

Novant Health Pediatric Gastroenterology - Cornelius · Cornelius, NC
Active · expires Jan 2, 2027
CLIA Number34D2274355
Laboratory TypePhysician Office
Certificate Effective DateJanuary 3, 2025
Certificate Expiration DateJanuary 2, 2027
Laboratory DirectorWilliam Houck
Laboratory Phone(704) 316-5060
Laboratory LocationNovant Health Pediatric Gastroenterology - Cornelius17810 Statesville Road Suite 311, Cornelius, NC 28031
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Novant Medical Group, Inc.'s NPI number?

The NPI number for Novant Medical Group, Inc. is 1013453604. It was assigned to this organization in the NPPES registry on January 6, 2017. The provider is doing business as Novant Health Pediatric Gastroenterology.

Where is Novant Medical Group, Inc. located?

Novant Medical Group, Inc. is located at 11840 Southmore Dr Suite 200, Charlotte, NC 28277. The listed phone number is (704) 316-5060.

What is Novant Medical Group, Inc.'s specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Pediatric Gastroenterology, with taxonomy code 2080P0206X.

Is Novant Medical Group, Inc. enrolled in Medicare?

Yes. Novant Medical Group, Inc. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Novant Medical Group, Inc.?

According to the CMS Revalidation Reassignment List (October 2026 release), 2,991 clinicians in 63 Medicare specialties reassign their Medicare billing to Novant Medical Group, Inc.. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (759), Family Practice (327) and Hospitalist (302). Of these, 7 practice at this address and 397 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Novant Medical Group, Inc. hold CLIA laboratory certificates?

Yes. 4 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Novant Medical Group, Inc. was last updated on August 16, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.