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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: August 09, 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

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.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CAROLINA MEDICORP ENTERPRISES, INC
Emergency Medicine
11840 SOUTHMORE DR, SUITE 100
CHARLOTTE, NC 28277
Mecklenburg County (704) 316-4440
DR. MOLLY ELIZABETH GRIMM DPT
Physical Therapist (Orthopedic)
11840 SOUTHMORE DR, SUITE 100
CHARLOTTE, NC 28277
Mecklenburg County (704) 316-4443
DR. GREGORY BIELEC M.D.
Physical Therapist
11840 SOUTHMORE DR, SUITE 100
CHARLOTTE, NC 28277
Mecklenburg County (704) 316-4443
DR. ERIN ELIZABETH BALL PT, DPT
Physical Therapist
11840 SOUTHMORE DR, SUITE 100
CHARLOTTE, NC 28277
Mecklenburg County (704) 316-4443
MR. ERIC R FORD PT
Physical Therapist
11840 SOUTHMORE DR, SUITE 100
CHARLOTTE, NC 28277
Mecklenburg County (704) 316-4443
MS. KRISTIN MICHELLE HIETBRINK PT
Physical Therapist
11840 SOUTHMORE DR, SUITE 100
CHARLOTTE, NC 28277
Mecklenburg County (704) 316-4443
MR. MATTHEW WILLIAM GRIMM P.T.
Physical Therapist
11840 SOUTHMORE DR, SUITE 100
CHARLOTTE, NC 28277
Mecklenburg County (704) 316-4443
DR. BRETT A. CHRISTOFFERSEN M.D.
Internal Medicine
11840 SOUTHMORE DR, SUITE 200
CHARLOTTE, NC 28277
Mecklenburg County (704) 384-1166

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.

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 4 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.