Coastal ER III, LLC

Primary specialty

Emergency Care Clinic/CenterTaxonomy code 261QE0002X

Legal business name

COASTAL ER III, LLC

Doing business as

Physicians Premier Emergency Room

Practice address

1860 Highway 181 Frontage Road
Ste C
Portland, TX 78374

Phone

(361) 991-0912

NPI assigned

Aug 10, 2015

Organization subpart

No

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

Authorized official

Name

Christopher Kwon, M.D.

Title

Manager

Phone

(361) 991-0912

Specialties & licenses 1

Addresses

Other names 1

• Physicians Premier Emergency Room Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093191397. Details of each certification follow.

• CCN 670168 Hospital · Terminated · Name & address match · Details

Hospital certification: CCN 670168

Legal name

PHYSICIANS PREMIER EMERGENCY ROOM

Certification status

Terminated Voluntary: merger or closure, Jan 1, 2022

Provider type (POS)

Hospital – Short-term

Participating since

Apr 29, 2020

Last certification

Apr 29, 2020

Beds

1

Ownership / control type

Private (not for profit)

Facility address

1860 Highway 181, Frontage Road
Portland, TX 78374

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

{
    "created_epoch": "1439164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704931200000",
    "number": "1093191397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6040",
            "city": "CORPUS CHRISTI",
            "state": "TX",
            "postal_code": "784666040",
            "telephone_number": "361-723-0226",
            "fax_number": "512-852-4625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1860 HIGHWAY 181 FRONTAGE ROAD",
            "address_2": "STE C",
            "city": "PORTLAND",
            "state": "TX",
            "postal_code": "78374",
            "telephone_number": "361-991-0912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL ER III, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-10",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A",
        "authorized_official_last_name": "KWON",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "361-991-0912",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QE0002X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Emergency Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Physicians Premier Emergency Room",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Physicians Premier Emergency Room",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Emergency Care Clinic/Center in Portland, TX
• Providers in Portland, TX by specialty
• Emergency Care Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.