Individual provider Active NPI

Michael Coletta, M.D.

  • Emergency Medicine Physician
  • Myrtle Beach, SC
National Provider Identifier
1073059911
Registry record updated Jan 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
25MA11137100 Issued in NJ
Practice address
809 82ND Pkwy
Myrtle Beach, SC 29572
Phone
(843) 692-1000
NPI assigned
Jan 17, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 17, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207P00000X 82076 SC
Emergency Medicine Physician 207P00000X 25MA11137100 NJ Primary

Addresses

Primary practice location

809 82ND Pkwy
Myrtle Beach, SC 29572

Mailing address

701 N Clayton St
Wilmington, DE 19805-3155
Phone (302) 421-4100

Other practice location 1

1 Cooper Plz
Camden, NJ 08103-1461
Phone (856) 342-2000

Other practice location 2

1 Cooper Plz
Camden, NJ 08103-1461
Phone (856) 342-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, DE, NJ3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20190802002194 SC Practitioner - Emergency Medicine 7113254822 Reassigns benefits to 1 organization
I20200409000087 DE Practitioner - Emergency Medicine 7113254822 Reassigns benefits to 1 organization
I20210727000041 NJ Practitioner - Emergency Medicine 7113254822 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Cooper Medical School of Rowan University, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergency Care Services of New Jersey PAGroup PAC ID 2567534100, 14 clinicians

Practice addresses (Care Compare)

509 N Broad St
Woodbury, NJ 08096-1617
Phone (856) 853-2001

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Physician Associates of Delaware PC Single Specialty CurrentSince Apr 2, 2020 Accepting new patients
Emergency Care Services of New Jersey, PA Single Specialty CurrentSince Mar 1, 2023 Accepting new patients
Prohealth Urgent Care Medicine of New Jersey LLP Single Specialty CurrentSince Aug 1, 2021 Accepting new patients
Acs Primary Care Physicians - Southeast PC Single Specialty CurrentSince Jul 1, 2019 Accepting new patients

Locations

701 N Clayton St
Wilmington, DE 19805
Phone (302) 421-4100

1210 Route 130 N
Ste 1438
Cinnaminson, NJ 08077
Phone (551) 313-0170

700 Mullica Hill Rd
Mullica Hill, NJ 08062
Phone (856) 508-1000

1 Harmon Plz
Ste 1010
Secaucus, NJ 07094

509 N Broad St
Woodbury, NJ 08096
Phone (856) 686-5396

809 82nd Pkwy
Myrtle Beach, SC 29572
Phone (843) 291-7182

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1484611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673913600000",
    "number": "1073059911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 N CLAYTON ST",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198053155",
            "telephone_number": "302-421-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "809 82ND PKWY",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "29572",
            "telephone_number": "843-692-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Cooper Plz",
            "address_purpose": "LOCATION",
            "city": "Camden",
            "state": "NJ",
            "postal_code": "081031461",
            "country_code": "US",
            "telephone_number": "856-342-2000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Cooper Plz",
            "address_purpose": "LOCATION",
            "city": "Camden",
            "state": "NJ",
            "postal_code": "081031461",
            "country_code": "US",
            "telephone_number": "856-342-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COLETTA",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-01-17",
        "last_updated": "2023-01-17",
        "certification_date": "2021-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine",
            "state": "SC",
            "license": "82076",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NJ",
            "license": "25MA11137100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

Verify at the official NPI Registry.