Coastline Medical Services PLLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

ME116308 Issued in FL

Legal business name

COASTLINE MEDICAL SERVICES PLLC

Practice address

1817 Lewis Turner Blvd Ste F
Fort Walton Beach, FL 32547-1349

Phone

(850) 396-1110

NPI assigned

Aug 23, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Michael Tavernaris, M.DNPI 1386888626

Title

Physician

Phone

(850) 396-1110

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael E Tavernaris, M.D.

  • Family Medicine Physician
  • Fort Walton Beach, FL
  • NPI 1386888626
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1471910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727395200000",
    "number": "1003361767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 MARY ESTHER BLVD",
            "city": "MARY ESTHER",
            "state": "FL",
            "postal_code": "325691687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1817 LEWIS TURNER BLVD STE F",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325471349",
            "telephone_number": "850-396-1110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTLINE MEDICAL SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-23",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-27",
        "status": "A",
        "authorized_official_last_name": "TAVERNARIS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "850-396-1110",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "FL",
            "license": "ME116308",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Coastal Periodontics Practice
• Coastal Radiology Associates PA
• Coastal Spa and Salon
• Coastal Vascular and Interventional PLLC
• Coastal Wound Care
• Catherine D Cobbs
• Scarlett Codd, SLP
• Mikayla R Cody, RBT
• Van Scott Cogley, D.D.S.
• Tavares Cohens

• Medical Specialty Clinic/Center in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Medical Specialty Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.