NOVANT HEALTH NORTHLAKE DERMATOLOGY
NPI 1396751640
Dermatology - Dermatopathology in Huntersville, NC

NPI Status: Active since July 31, 2006

Contact Information

9604 HOLLY POINT DR
HUNTERSVILLE, NC
ZIP 28078
Phone: (704) 316-5070
Fax: (704) 316-5075

NPI Profile Information
Primary Taxonomy
Secondary Taxonomies
Group Taxonomy
Insurance Plans Accepted
Authorized Official
CLIA Information
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Organization
Dermatology
Dermatopathology
Accepts Insurance
CLIA Number: 34D1058814
CLIA Cert. Type: Physician Office
CLIA Exp. Date: 02-12-2026

About NOVANT HEALTH NORTHLAKE DERMATOLOGY

This page provides the complete NPI Profile along with additional information for Novant Health Northlake Dermatology, a provider established in Huntersville, North Carolina operating as a Dermatology, focusing in dermatopathology . The healthcare provider is registered in the NPI registry with number 1396751640 assigned on July 2006. The practitioner's primary taxonomy code is 207ND0900X. The provider is registered as an organization and their NPI record was last updated one year ago. Novant Health Northlake Dermatology operates as a multi-specialty business group with one or more individual providers who practice different areas of specialization. The provider's is doing business as Novant Health Northlake Dermatology. The authorized official of this NPI record is Leea Jeanine Walton (Rcs Manager)

NPI: 1396751640
Provider Legal Name: NOVANT HEALTH MEDICAL GROUP, LLC
Other Organization Name: NOVANT HEALTH NORTHLAKE DERMATOLOGY
Other Name Type: Doing Business As (3)
Entity Type: Organization
Location Address: 9604 HOLLY POINT DR HUNTERSVILLE, NC 28078
Location Phone: (704) 316-5070
Location Fax: (704) 316-5075
Mailing Address: PO BOX 60447 CHARLOTTE, NC 28260
Mailing Phone: (704) 316-5070
Mailing Fax: (704) 316-5075
Is Sole Proprietor?: No
Is Organization Subpart?: No
Enumeration Date: 07-31-2006
Last Update Date: 06-19-2024
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Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification: Dermatology Dermatopathology
Taxonomy Code: 207ND0900X
Type: Allopathic & Osteopathic Physicians
Taxonomy Description: A dermatopathologist has the expertise to diagnose and monitor diseases of the skin including infectious, immunologic, degenerative and neoplastic diseases. This entails the examination and interpretation of specially prepared tissue sections, cellular scrapings and smears of skin lesions by means of routine and special (electron and fluorescent) microscopes.

Secondary Taxonomies

The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.

No.	Taxonomy Code	Type	Classification / Specialization	License No. (State)
1	207N00000X	Allopathic & Osteopathic Physicians	Dermatology

Group Taxonomy 193200000X MULTI-SPECIALTY GROUP

This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

Blue Cross and Blue Shield of NC

Blue Advantage Bronze Basic | 3 Free PCP | $20 Tier 1 Rx | Integrated | Nationwide Doctors - PPO
Blue Advantage Bronze Complete | $60 PCP | $20 Tier 1 Rx | Nationwide Doctors - PPO
Blue Advantage Bronze Standard | Nationwide Doctors - PPO
Blue Advantage Gold Premier | 3 Free PCP | $10 Tier 1 Rx | Nationwide Doctors - PPO
Blue Advantage Gold Standard | Nationwide Doctors - PPO
Blue Advantage Silver Choice | 3 Free PCP | $15 Tier 1 Rx | Nationwide Doctors - PPO
Blue Advantage Silver Preferred | 3 Free PCP | $10 Tier 1 Rx | Integrated | Nationwide Doctors - PPO
Blue Advantage Silver Standard | Nationwide Doctors - PPO
Blue Care Bronze Standard | Statewide Doctors - HMO
Blue Care Gold Standard | Statewide Doctors - HMO
Blue Care Silver Standard | Statewide Doctors - HMO
Blue Home Bronze Basic | 3 Free PCP | $20 Tier 1 Rx | Integrated | with Novant Health - EPO
Blue Home Bronze Standard | with Novant Health - EPO
Blue Home Gold Premier | 3 Free PCP | $10 Tier 1 Rx | with Novant Health - EPO
Blue Home Gold Standard | with Novant Health - EPO
Blue Home Silver Preferred | 3 Free PCP | $10 Tier 1 Rx | Integrated | with Novant Health - EPO
Blue Home Silver Standard | with Novant Health - EPO
Blue Value Bronze Basic | 3 Free PCP | $20 Tier 1 Rx | Integrated | Limited Statewide Doctors - POS
Blue Value Bronze Complete | $60 PCP | $20 Tier 1 Rx | Limited Statewide Doctors - POS
Blue Value Bronze Standard | Limited Statewide Doctors - POS

Cigna Healthcare

Connect Bronze 5500 Indiv Med Deductible - HMO
Connect Bronze 6500 Indiv Med Deductible - HMO
Connect Bronze CMS Standard - HMO
Connect Gold CMS Standard - HMO
Connect Silver 3500 Indiv Med Deductible - HMO
Connect Silver 4400 Indiv Med Deductible - HMO
Connect Silver CMS Standard - HMO

Blue Cross Blue Shield

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Medicare

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Medicaid

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name: LEEA JEANINE WALTON
Authorized Official Title: RCS MANAGER
Authorized Official Phone: (704) 316-6081

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier	Type / Code	Identifier State	Identifier Issuer
018GV	OTHER (01)	NC	BCBS
NPB181	MEDICAID (05)	SC
5904331	MEDICAID (05)	NC

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number: 34D1058814
Facility Type: Physician Office
Certificate Effective Date: February 13, 2024
Certificate Expiration Date: February 12, 2026
Laboratory Director: JOSE R. PENA
Certificate Type: Certificate of Compliance
Certificate Type Description: This CLIA certificate is issued to Novant Health Northlake Dermatology after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements. This type of certificate is issued to laboratories that perform nonwaived (moderate and/or high complexity) testing.

NPI Validation Check Digit Calculation

The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1	3	9	6	7	5	1	6	4	0
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2	3	18	6	14	5	2	6	8
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 3 + 1 + 8 + 6 + 1 + 4 + 5 + 2 + 6 + 8 + 24 = 70
Step 3: because the number obtained in step 2 ends in zero, the check digit is zero.
									0

The NPI number 1396751640 is valid because the calculated check digit 0 using the Luhn validation algorithm matches the last digit of the original NPI number.