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NOVANT HEALTH CHILD AND ADOLESCENT MEDICAL GROUP
NPI 1386019891
Pediatrics - Adolescent Medicine in Waxhaw, NC

Active since December 09, 2015
3614 PROVIDENCE RD S, SUITE 101, WAXHAW, NC 28173(704) 384-8460(704) 384-8465 Get Directions Write a Review

NPPES record last updated: June 20, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jun 20, 2024, Jul 10, 2023, Aug 16, 2021 and 2 more (5 updates tracked since 2015).

About Novant Health Child And Adolescent Medical Group NPPES

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

NOVANT HEALTH CHILD AND ADOLESCENT MEDICAL GROUP (NPI 1386019891) is a healthcare organization registered as an adolescent medicine in Waxhaw, North Carolina and active in the NPI registry since December 2015. The organization lists Leea Jeanine Walton, Rcs Manager, as its authorized official.

NPPES Registry Identity

NPI1386019891
Entity TypeOrganization
Primary Taxonomy2080A0000X
Legal Business NameNOVANT HEALTH MEDICAL GROUP, LLC
Location Address3614 PROVIDENCE RD S, SUITE 101Waxhaw, NC 28173-6309
Mailing AddressPo Box 60447Charlotte, NC 28260-0447 · (704) 384-7840
Phone(704) 384-8460
Fax(704) 384-8465
Organization SubpartNo
Authorized OfficialLeea Jeanine WaltonRcs Manager · (704) 316-6081
Enumeration DateDecember 9, 2015
Last NPPES UpdateJune 20, 20245 updates tracked since enumeration
NPPES CertifiedJune 20, 2024
✔ NPI 1386019891 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatrics · Adolescent MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2080A0000X
Definition
A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.
3614 PROVIDENCE RD S, Waxhaw, NC 28173
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Other Names 1

Doing Business AsNovant Health Child And Adolescent Medical Group

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, Cigna Healthcare.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Novant Health Child And Adolescent Medical Group is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2,991

Medicare enrollment records show 2,991 clinicians reassign Medicare billing to Novant Health Child And Adolescent Medical Group, which bills Medicare for the services they deliver. Of these, 10 practice at this address and 126 within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 63

Nurse Practitioner759
Family Practice327
Hospitalist302
Pediatric Medicine233
Obstetrics/Gynecology187
Internal Medicine178
Neurology150
Cardiovascular Disease (Cardiology)94
55 other specialties761

Nearest to this location (20)

See all 2,991
Susan Duncan-Butler, M.D.
Pediatric Medicine
NPI 1184621534
3614 PROVIDENCE RD S STE 101
Waxhaw, NC 28173
(704) 384-8460
✔ PECOSSame address
Christopher Foster, F.N.P.
Nurse Practitioner
NPI 1295081123
3614 S PROVIDENCE RD STE 200
Waxhaw, NC 28173
(704) 384-8640
✔ PECOS✔ Accepts MedicareSame address
Howard Guthmann, M.D.
Family Practice
NPI 1134181118
3614 PROVIDENCE RD S STE 200
Waxhaw, NC 28173
(704) 384-8640
✔ PECOS✔ Accepts MedicareSame address
Gin Lou
Family Practice
NPI 1548577232
3614 S PROVIDENCE RD STE 200
Waxhaw, NC 28173
(704) 384-8640
✔ PECOS✔ Accepts MedicareSame address
Robert Malecki, M.D.
Family Practice
NPI 1497979611
3614 PROVIDENCE RD S SUITE 200
Waxhaw, NC 28173
(704) 384-8640
✔ PECOS✔ Accepts MedicareSame address
Leena Mitchell, FNP-C
Nurse Practitioner
NPI 1487137055
3614 PROVIDENCE RD S STE 200
Waxhaw, NC 28173
(704) 384-8640
✔ PECOS✔ Accepts MedicareSame address
Thao Nguyen, M.D.
Family Practice
NPI 1073798419
3614 S PROVIDENCE RD STE 200
Waxhaw, NC 28173
(704) 384-8640
✔ PECOS✔ Accepts MedicareSame address
Resha Shrestha, MD
Family Practice
NPI 1770147084
3614 S PROVIDENCE RD STE 200
Waxhaw, NC 28173
(704) 384-8640
✔ PECOS✔ Accepts MedicareSame address
Mildred Williams, FNP
Nurse Practitioner
NPI 1548644826
3614 PROVIDENCE RD S STE 200
Waxhaw, NC 28173
(704) 384-8640
✔ PECOS✔ Accepts MedicareSame address
Kavita Shanker-Patel, M.D.
Family Practice
NPI 1124384789
3614 PROVIDENCE RD S STE 200
Waxhaw, NC 28173
(704) 384-8640
✔ PECOS✔ Accepts MedicareSame address
Alessandra Tozzi
Family Practice
NPI 1770288235
6237 CAROLINA COMMONS DR STE 101
Fort Mill, SC 29707
(803) 548-9393
✔ PECOS4.8 mi
Jennifer Mock, M.D.
Obstetrics/Gynecology
NPI 1639252026
6488 WEDDINGTON-MONROE ROAD
Wesley Chapel, NC 28104
(704) 384-1020
✔ PECOS✔ Accepts Medicare5.3 mi
Thomas Pittman, MD
Pediatric Medicine
NPI 1366829012
6488 WEDDINGTON-MONROE RD
Wesley Chapel, NC 28104
(704) 384-8460
✔ PECOS5.3 mi
Holly Smith, M.D.
Nurse Practitioner
NPI 1689749418
6488 WEDDINGTON-MONROE RD
Wesley Chapel, NC 28104
(704) 384-8460
✔ PECOS5.3 mi
Marie Watson, CNM
Certified Nurse Midwife (CNM)
NPI 1336667146
6488 WEDDINGTON-MONROE ROAD
Wesley Chapel, NC 28104
(704) 384-1020
✔ PECOS5.3 mi
Sofia Gkoulgkountina, DO
Family Practice
NPI 1215632682
6480 WEDDINGTON RD
Wesley Chapel, NC 28104
(704) 316-5650
✔ PECOS5.4 mi
Matthew Malus, MD
Rheumatology
NPI 1396107009
8500 CHARLOTTE HWY
Indian Land, SC 29707
(939) 275-8305
✔ PECOS✔ Accepts Medicare5.7 mi
Aspasia Ralli-Koukoutsis, MS
Mental Health Counselor
NPI 1861678377
9929 REA RD STE 201
Waxhaw, NC 28173
(704) 316-1650
✔ PECOS✔ Accepts Medicare6.0 mi
Tyrone Matthews, LCSW
Clinical Social Worker
NPI 1043533045
9929 REA RD STE 201
Waxhaw, NC 28173
(704) 316-1650
✔ PECOS✔ Accepts Medicare6.0 mi
Jessica Parker, M.D.
Neurology
NPI 1063702306
9929 REA RD
Waxhaw, NC 28173
(704) 316-1055
✔ PECOS✔ Accepts Medicare6.0 mi
See all 2,991 clinicians

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 1386019891. It was assigned to this organization in the NPPES registry on December 9, 2015. The provider is doing business as Novant Health Child And Adolescent Medical Group.

Where is Novant Health Medical Group, LLC located?

Novant Health Medical Group, LLC is located at 3614 Providence Rd S Suite 101, Waxhaw, NC 28173. The listed phone number is (704) 384-8460.

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

The primary specialty registered for this NPI is Pediatrics, specializing in Adolescent Medicine, with taxonomy code 2080A0000X.

Is Novant Health Medical Group, LLC enrolled in Medicare?

Yes. Novant Health Medical Group, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Novant Health Medical Group, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2,991 clinicians in 63 Medicare specialties reassign their Medicare billing to Novant Health Medical Group, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (759), Family Practice (327) and Hospitalist (302). Of these, 10 practice at this address and 126 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Novant Health Medical Group, LLC accept?

Health plans from Blue Cross and Blue Shield of NC and Cigna Healthcare 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.