Coastal Neurology Associates

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

COASTAL NEUROLOGY ASSOCIATES

Practice address

729 Professional Dr
New Bern, NC 28560-4547

Phone

(252) 633-3744

NPI assigned

Apr 12, 2007

Organization subpart

No

Name

Dr. Khaled Jreisat, MD

Title

Physician

Phone

(252) 633-3744

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 15, 2010.

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266192000000",
    "number": "1013131820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "729 PROFESSIONAL DR",
            "city": "NEW BERN",
            "state": "NC",
            "postal_code": "285604547",
            "telephone_number": "252-633-3744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "729 PROFESSIONAL DR",
            "city": "NEW BERN",
            "state": "NC",
            "postal_code": "285604547",
            "telephone_number": "252-633-3744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL NEUROLOGY ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2010-02-15",
        "status": "A",
        "authorized_official_last_name": "JREISAT",
        "authorized_official_first_name": "KHALED",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "252-633-3744",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8912867",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS GROUP NUMBER",
            "identifier": "01344",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BALLANGER INDIVIDUAL #",
            "identifier": "12867",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JREISAT BCBS INDIVIDUAL",
            "identifier": "45782",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8901344",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8945782",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in New Bern, NC
• Specialist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.