Extended Care Physicians - Coastal, PA

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

Legal business name

EXTENDED CARE PHYSICIANS - COASTAL, PA

Practice address

1013 Porters Neck Rd
Suite 130
Wilmington, NC 28411-8130

Phone

(910) 795-1471

NPI assigned

Apr 16, 2008

Last updated

Mar 19, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Robin Gleeson-Warren

Title

Director of Credentialing

Phone

(828) 210-2678

Specialties & licenses 7

Addresses

Other identifiers 1

Locations

Practitioners 5

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.

• Reagan L Ivey, NP

  • Primary Care Nurse Practitioner
  • Fayetteville, NC
  • NPI 1164414538
  NPD
• Craig Jerome, FNP

  • Family Nurse Practitioner
  • Cary, NC
  • NPI 1104100171
  NPD
• Stephen J Liederbach, M.D.

  • Internal Medicine Physician
  • Wilmington, NC
  • NPI 1578604641
  NPD
• John Steven Corder, M.D.

  • Family Medicine Physician
  • Asheville, NC
  • NPI 1154300820

  Geriatric Medicine

  NPD (past)
• Kimberly C Wexler, PAC

  • Physician Assistant
  • Asheville, NC
  • NPI 1588801906
  NPD (past)

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

{
    "created_epoch": "1208304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395187200000",
    "number": "1114191525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 890194",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282890194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1013 PORTERS NECK RD",
            "address_2": "SUITE 130",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284118130",
            "telephone_number": "910-795-1471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXTENDED CARE PHYSICIANS - COASTAL, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-16",
        "last_updated": "2014-03-19",
        "status": "A",
        "authorized_official_last_name": "GLEESON-WARREN",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "828-210-2678"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207QH0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5918852",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Geriatric Medicine (Family Medicine) Physician in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Geriatric Medicine (Family Medicine) Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2014; 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.