Gulf Coast Vascular Care, LLC

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

GULF COAST VASCULAR CARE, LLC

Practice address

14219 Cook Rd
Biloxi, MS 39532-9719

Phone

(228) 207-0810

NPI assigned

Sep 11, 2020

Organization subpart

No

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

Authorized official

Name

Kevin Gardner

Title

Operations Officer

Phone

(727) 474-0090

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

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 7

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

• Satjit Adlakha, D.O.

  • Interventional Cardiology Physician
  • Pascagoula, MS
  • NPI 1356550594
  Medicare reassignment Care Compare group NPD
• Bart J. Edmiston Sr., MD

  • Anesthesiology Physician
  • Ocean Springs, MS
  • NPI 1508934464
  Medicare reassignment Care Compare group NPD
• Rogin Subedi, MD

  • Cardiovascular Disease Physician
  • Ocean Springs, MS
  • NPI 1154797991
  Medicare reassignment Care Compare group NPD
• Ediz Tasan, M.D.

  • Cardiovascular Disease Physician
  • Pascagoula, MS
  • NPI 1053670166
  Medicare reassignment Care Compare group NPD
• Ghulam Awan, MD

  • Internal Medicine Physician
  • Mobile, AL
  • NPI 1760431662

  MS

  Medicare reassignment Care Compare group NPD
• Tammy Nicole Reus, MSN, FNP-C

  • Family Nurse Practitioner
  • Ocean Springs, MS
  • NPI 1235943341
  Medicare reassignment NPD
• Eric Louis Hall, M.D.

  • Diagnostic Radiology Physician
  • Baton Rouge, LA
  • NPI 1295976272

  MS, Vascular & Interventional Radiology

  Medicare reassignment NPD

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

{
    "created_epoch": "1599782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599782400000",
    "number": "1043825540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 PALM HARBOR BLVD STE A",
            "city": "PALM HARBOR",
            "state": "FL",
            "postal_code": "346831930",
            "telephone_number": "727-474-0090",
            "fax_number": "727-474-0055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14219 COOK RD",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "395329719",
            "telephone_number": "228-207-0810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULF COAST VASCULAR CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-11",
        "last_updated": "2020-09-11",
        "certification_date": "2020-09-11",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "OPERATIONS OFFICER",
        "authorized_official_telephone_number": "727-474-0090"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gulf Coast Physical Therapy Centers PA
• Gulf Coast Physical Therapy Centers PA
• Gulf Coast Physical Therapy Centers PA
• Gulf Coast Urgent Care, LLC
• Gulf Coast Vamc
• Gulf Coast Veterans Health Care System
• Gulf Coast Wellness Center Inc
• Gulf Medical, LLC
• Gulf Shores Adult Day Care
• Gulfsouth Radiology P a

• Nephrology Physician in Biloxi, MS
• Providers in Biloxi, MS by specialty
• Nephrology Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2020; 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.