NPIMap

Organization Active NPI

Coastal Cardiololgy & Vascular Center

  • Internal Medicine Physician
  • Port Charlotte, FL
National Provider Identifier
1033494547
Registry record updated Oct 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
COASTAL CARDIOLOLGY & VASCULAR CENTER
Practice address
1620 Tamiami TRL
Suite 300
Port Charlotte, FL 33948-4015
Phone
(941) 625-6187
Fax
(941) 625-7887
NPI assigned
Oct 15, 2011
Last updated
Oct 15, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2011

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

Authorized official

Name
Dr. Bala Nandigam, M.D.NPI 1306879119
Title
President
Phone
(941) 625-6187

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X

Addresses

Primary practice location

1620 Tamiami TRL
Suite 300
Port Charlotte, FL 33948-4015

Mailing address

1620 Tamiami TRL
Suite 300
Port Charlotte, FL 33948-4015
Phone (941) 625-6187

National Provider Directory

National Provider Directory

Locations

1620 Tamiami Trl
Ste 300
Port Charlotte, FL 33948
Phone (941) 625-6187

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1318636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318636800000",
    "number": "1033494547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 TAMIAMI TRL",
            "address_2": "SUITE 300",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339484015",
            "telephone_number": "941-625-6187",
            "fax_number": "941-625-7887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 TAMIAMI TRL",
            "address_2": "SUITE 300",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339484015",
            "telephone_number": "941-625-6187",
            "fax_number": "941-625-7887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL CARDIOLOLGY & VASCULAR CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-15",
        "last_updated": "2011-10-15",
        "status": "A",
        "authorized_official_last_name": "NANDIGAM",
        "authorized_official_first_name": "BALA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "941-625-6187",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Charlotte, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2011; 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.