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NOVANT HEALTH LAKESIDE PRIMARY CARE
NPI 1063771749
Family Medicine in Charlotte, NC

Active since May 15, 2012CLIA 34D2048319 · Waiver
13460 PLAZA ROAD EXT STE 100, CHARLOTTE, NC 28215(704) 316-4990(704) 316-4998 Get Directions Write a Review

NPPES record last updated: July 9, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 9, 2024, Jul 11, 2023, Aug 16, 2021 and 1 more (4 updates tracked since 2020).

About Novant Health Lakeside Primary Care NPPES

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

NOVANT HEALTH LAKESIDE PRIMARY CARE (NPI 1063771749) is a healthcare organization registered as a family medicine in Charlotte, North Carolina and active in the NPI registry since May 2012. The organization holds a CLIA Waiver certificate valid through May 5, 2028 and lists Leea Jeanine Walton, Rcs Manager, as its authorized official.

NPPES Registry Identity

NPI1063771749
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameNOVANT HEALTH MEDICAL GROUP, LLC
Location Address13460 PLAZA ROAD EXT STE 100Charlotte, NC 28215-8923
Mailing AddressPo Box 60447Charlotte, NC 28260-0447 · (704) 384-7603 · Fax (704) 417-4479
Phone(704) 316-4990
Fax(704) 316-4998
Organization SubpartNo
Authorized OfficialLeea Jeanine WaltonRcs Manager · (704) 316-6081
Enumeration DateMay 15, 2012
Last NPPES UpdateJuly 9, 20244 updates tracked since enumeration
NPPES CertifiedJuly 9, 2024
✔ NPI 1063771749 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
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.
13460 PLAZA ROAD EXT STE 100, Charlotte, NC 28215
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Other Names 1

Doing Business AsNovant Health Lakeside Primary Care

Other Identifiers 1

Medicaid5921588NC

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

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of NC.Insurance ›

CLIA Laboratory Certificates CMS CLIA

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 34D2048319

Novant Health Lakeside Primary Care - Brookdale · Charlotte, NC
Active · expires May 5, 2028
CLIA Number34D2048319
Laboratory TypePhysician Office
Certificate Effective DateMay 6, 2026
Certificate Expiration DateMay 5, 2028
Laboratory DirectorDr. Lalonda M. Graham
Laboratory Phone(704) 384-4990
Laboratory LocationNovant Health Lakeside Primary Care - Brookdale13460 Plaza Road Extension, Suite 100, Charlotte, NC 28215
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 14

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

KAITLIN SIMPSON WRIGHT FNP
Nurse Practitioner
13460 PLAZA ROAD EXT STE 100
CHARLOTTE, NC 28215
Mecklenburg County (980) 488-9450
CARLY RIVET HAMLIN MD
Internal Medicine
13460 PLAZA ROAD EXT STE 100
CHARLOTTE, NC 28215
Mecklenburg County (980) 488-9450
MS. TIFFANY BRINTLE REISSER MSN, FNP-C
Nurse Practitioner
13460 PLAZA ROAD EXT STE 100
CHARLOTTE, NC 28215
Mecklenburg County (704) 316-4990
DR. AMANDA JOY WHITLEY MD
Family Medicine
13460 PLAZA ROAD EXT STE 100
CHARLOTTE, NC 28215
Mecklenburg County (704) 316-4990
BRITTNEY CHANTEL COLE MD
Family Medicine
13460 PLAZA ROAD EXT STE 100
CHARLOTTE, NC 28215
Mecklenburg County (704) 316-4990
NAJEEBURREHMAN BAMS KARIMI PA
Physician Assistant
13460 PLAZA ROAD EXT STE 100
CHARLOTTE, NC 28215
Mecklenburg County (704) 316-4990
LOPEZ DUANE DAVIS II
Family Medicine
13460 PLAZA ROAD EXT STE 100
CHARLOTTE, NC 28215
Mecklenburg County (704) 316-4990
NOVANT HEALTH PIEDMONT NORTH CAROLINA MEDICAL GROUP, LLC
Internal Medicine
13460 PLAZA ROAD EXT STE 100
CHARLOTTE, NC 28215
Mecklenburg County (980) 488-9450

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 Health Medical Group, LLC's NPI number?

The NPI number for Novant Health Medical Group, LLC is 1063771749. It was assigned to this organization in the NPPES registry on May 15, 2012. The provider is doing business as Novant Health Lakeside Primary Care.

Where is Novant Health Medical Group, LLC located?

Novant Health Medical Group, LLC is located at 13460 Plaza Road Ext Ste 100, Charlotte, NC 28215. The listed phone number is (704) 316-4990.

What is Novant Health Medical Group, LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Novant Health Medical Group, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 34D2048319) is associated with this NPI, valid through May 5, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Novant Health Medical Group, LLC accept?

Health plans from Blue Cross and Blue Shield of NC list Novant Health Medical Group, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Novant Health Medical Group, LLC was last updated on July 9, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.