Newly Listed Provider — this NPI profile has been added to the NPI registry within the last 90 days.
NOVANT HEALTH MEDICAL GROUP NC COASTAL REGION SPECIALTY, LLC
Complete NPI Record 1124922539
Obstetrics & Gynecology - Gynecologic Oncology in Carolina Shores, NC
Active since October 07, 2026
Complete NPI Dataset
This page contains the complete raw NPPES record for Novant Health Medical Group Nc Coastal Region Specialty, Llc (NPI 1124922539), an obstetrics & gynecology organization in Carolina Shores, NC. All 29 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, Markdown or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1124922539 Field 1/29
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 2 Field 2/29
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Employer Identification Number EIN: Not available Field 3/29
- The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
- Provider Organization Name Legal Business Name: NOVANT HEALTH MEDICAL GROUP NC COASTAL REGION SPECIALTY, LLC Field 4/29
- The name of the organization provider. If the provider is an organization, this is the legal business name.
- Provider Other Organization Name: Not available Field 5/29
- Other name by which the organization provider is or has been known.
- Provider Other Organization Name Type Code: 6 Field 6/29
- Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
- Provider First Line Business Mailing Address: PO BOX 604532 Field 7/29
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: CHARLOTTE Field 8/29
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: NC Field 9/29
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 282604532 Field 10/29
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 11/29
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider First Line Business Practice Location Address: 75 EMERSON BAY RD STE 104 Field 12/29
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: CAROLINA SHORES Field 13/29
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: NC Field 14/29
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 284672498 Field 15/29
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 16/29
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 9106673000 Field 17/29
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 9103380965 Field 18/29
- The fax number associated with the location address of the provider being identified.
- Authorized Official Last Name: WALTON Field 21/29
- The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
- Authorized Official First Name: LEEA Field 22/29
- The first name of the authorized official.
- Authorized Official Middle Name: JEANINE Field 23/29
- The middle name of the authorized official.
- Authorized Official Title or Position: RCS MANAGER Field 24/29
- The title or position of the authorized official.
- Authorized Official Telephone Number: 3365157085 Field 25/29
- The 10-position telephone number of the authorized official.
- Healthcare Provider Taxonomy Code 1: 207VX0201X Field 26/29
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 1: Y Field 27/29
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Is Organization Subpart: N Field 28/29
- Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
Other Organization Names 1
Additional business and trade names this provider has on file with the NPPES registry.
Novant Health Cancer Institute Doing Business As
Name 1/1Doing Business As: A trade name or operating name under which an organization provides services, distinct from its registered legal business name.
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