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NOVANT HEALTH PEDIATRICS BRUNSWICK
NPI 1235798992
Pediatrics in Supply, NC

Active since June 06, 2019CLIA 34D2170564 · Certificate of Compliance
20 MEDICAL CAMPUS DR NW STE 205, SUPPLY, NC 28462(704) 384-0517 Get Directions Write a Review

NPPES record last updated: June 20, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jun 20, 2024, Jul 11, 2023, Aug 16, 2021 and 1 more (4 updates tracked since 2019).

About Novant Health Pediatrics Brunswick NPPES

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

NOVANT HEALTH PEDIATRICS BRUNSWICK (NPI 1235798992) is a healthcare organization registered as a pediatrics in Supply, North Carolina and active in the NPI registry since June 2019. The organization holds a CLIA Certificate of Compliance certificate valid through March 15, 2028 and lists Leea Jeanine Walton, Rcs Manager, as its authorized official.

NPPES Registry Identity

NPI1235798992
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameNOVANT HEALTH MEDICAL GROUP, LLC
Location Address20 MEDICAL CAMPUS DR NW STE 205Supply, NC 28462-4094
Mailing AddressPo Box 60447Charlotte, NC 28260-0447
Phone(704) 384-0517
Organization SubpartNo
Authorized OfficialLeea Jeanine WaltonRcs Manager · (704) 316-6081
Enumeration DateJune 6, 2019
Last NPPES UpdateJune 20, 20244 updates tracked since enumeration
NPPES CertifiedJune 20, 2024
✔ NPI 1235798992 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
20 MEDICAL CAMPUS DR NW STE 205, Supply, NC 28462
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Other Names 1

Doing Business AsNovant Health Pediatrics Brunswick

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 Ambetter from Absolute Total Care, Ambetter of North Carolina, Ambetter of Tennessee and more.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 Compliance 34D2170564

Novant Health Pediatrics - Brunswick · Supply, NC
Active · expires Mar 15, 2028
CLIA Number34D2170564
Laboratory TypePhysician Office
Certificate Effective DateMarch 16, 2026
Certificate Expiration DateMarch 15, 2028
Laboratory DirectorLori A. Tackman
Laboratory Phone(910) 721-4400
Laboratory LocationNovant Health Pediatrics - Brunswick20 Medical Campus Drive Suite 205, Supply, NC 28462
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES 3

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

LORI ANNE TACKMAN MD
Pediatrics
20 MEDICAL CAMPUS DR NW STE 205
SUPPLY, NC 28462
Brunswick County (910) 721-4400
NICOLE EMILY NYBERG N.P.
Nurse Practitioner
20 MEDICAL CAMPUS DR NW STE 205
SUPPLY, NC 28462
Brunswick County (910) 721-4400
DR. BRIAN JAMES MCKLINDON DNP, FNP-C
Student in an Organized Health Care Education/Training Program
20 MEDICAL CAMPUS DR NW STE 205
SUPPLY, NC 28462
Brunswick County (910) 721-4400

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 1235798992. It was assigned to this organization in the NPPES registry on June 6, 2019. The provider is doing business as Novant Health Pediatrics Brunswick.

Where is Novant Health Medical Group, LLC located?

Novant Health Medical Group, LLC is located at 20 Medical Campus Dr NW Ste 205, Supply, NC 28462. The listed phone number is (704) 384-0517.

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

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

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

Yes. A Certificate of Compliance (number 34D2170564) is associated with this NPI, valid through March 15, 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 Ambetter from Absolute Total Care, Ambetter of North Carolina, Ambetter of Tennessee and 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 June 20, 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.