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NOVANT HEALTH LAKESIDE PRIMARY CARE
NPI 1114105533
Family Medicine in Locust, NC

Active since February 07, 2008CLIA 34D1076519 · Waiver
236 MARKET ST, SUITE 110, LOCUST, NC 28097(704) 384-9590(704) 384-9591 Get Directions Write a Review

NPPES record last updated: July 9, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jul 9, 2024, Jul 11, 2023, Aug 16, 2021 (3 updates tracked since 2021).

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 1114105533) is a healthcare organization registered as a family medicine in Locust, North Carolina and active in the NPI registry since February 2008. The organization holds a CLIA Waiver certificate valid through January 30, 2027 and lists Leea Jeanine Walton, Rcs Manager, as its authorized official.

NPPES Registry Identity

NPI1114105533
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameNOVANT HEALTH MEDICAL GROUP, LLC
Location Address236 MARKET ST, SUITE 110Locust, NC 28097-9439
Mailing AddressPo Box 60447Charlotte, NC 28260-0447 · (704) 384-9590 · Fax (704) 384-9591
Phone(704) 384-9590
Fax(704) 384-9591
Organization SubpartNo
Authorized OfficialLeea Jeanine WaltonRcs Manager · (704) 316-6081
Enumeration DateFebruary 7, 2008
Last NPPES UpdateJuly 9, 20243 updates tracked since enumeration
NPPES CertifiedJuly 9, 2024
✔ NPI 1114105533 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ 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.
Also ListedInternal MedicineTaxonomy 207R00000X
236 MARKET ST, Locust, NC 28097
Open in Google Maps ↗

Other Names 1

Doing Business AsNovant Health Lakeside Primary Care

Other Identifiers 1

Medicaid5909009NC

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 34D1076519

Novant Health Lakeside Primary Care - Locust · Locust, NC
Active · expires Jan 30, 2027
CLIA Number34D1076519
Laboratory TypePhysician Office
Certificate Effective DateJanuary 31, 2025
Certificate Expiration DateJanuary 30, 2027
Laboratory DirectorRaymond Perez
Laboratory Phone(704) 384-9590
Laboratory LocationNovant Health Lakeside Primary Care - Locust236 Market Street, Suite 110, Locust, NC 28097
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 4

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

DR. JASON ELLIS MARTIN DDS
Dentist (General Practice)
236 MARKET ST, SUITE 200
LOCUST, NC 28097
Stanly County (704) 781-0500
DAVID E THOME DDS PLLC VIII
Dentist (Pediatric Dentistry)
236 MARKET ST, SUITE 200
LOCUST, NC 28097
Stanly County (704) 604-0353
DR. RICARDO VARGAS M.D.
Family Medicine
236 MARKET ST, SUITE 110
LOCUST, NC 28097
Stanly County (704) 384-9590
DR. JASON F BAKER DDS
Dentist
236 MARKET ST, SUITE 200
LOCUST, NC 28097
Stanly County (704) 781-0500

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 1114105533. It was assigned to this organization in the NPPES registry on February 7, 2008. 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 236 Market St Suite 110, Locust, NC 28097. The listed phone number is (704) 384-9590.

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 34D1076519) is associated with this NPI, valid through January 30, 2027. 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.