NPIMap

Organization Active NPI

Coastal Skin Surgery and Dermatology, PL

  • MOHS-Micrographic Surgery Physician
  • Miramar Beach, FL
National Provider Identifier
1114238193
Registry record updated Apr 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
License
ME92098 Issued in FL
Legal business name
COASTAL SKIN SURGERY AND DERMATOLOGY, PL
Practice address
12469 Emerald Coast Pkwy W
Suite 101
Miramar Beach, FL 32550-8305
Phone
(850) 654-3376
Fax
(850) 654-3320
NPI assigned
Jun 24, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2011

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

Authorized official

Name
David C Adams, MDNPI 1528042256
Title
Owner, President
Phone
(850) 654-3376

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X
MOHS-Micrographic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0101X ME92098 FL Primary

Addresses

Primary practice location

12469 Emerald Coast Pkwy W
Suite 101
Miramar Beach, FL 32550-8305

Mailing address

12469 Emerald Coast Pkwy W
Suite 101
Miramar Beach, FL 32550-8305
Phone (850) 654-3376

Other identifiers 1

IdentifierTypeStateIssuer
00175OtherFLBCBSFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101013000909 FL Part B Supplier - Clinic/Group Practice 3173715869 Receives reassigned benefits from 26 practitioners
Practice locations: Fort Walton BCH, FL; Fort Walton Beach, FL; Miramar Beach, FL; Niceville, FL; Panama City Beach, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D1091593Coastal Skin Surgery and Dermatology12469 Emerald Coast Pkwy Ste 101, Miramar Beach, FL 32550ComplianceDec 17, 2026

National Provider Directory

National Provider Directory

Locations

912 Mar Walt Dr
Fort Walton Beach, FL 32547
Phone (850) 314-7546

914 Mar Walt Dr
#A
Fort Walton Beach, FL 32547
Phone (599) 906-1390

12469 US Highway 98 W
Miramar Beach, FL 32550
Phone (850) 650-7877

12469 US Highway 98 W
Ste 101
Miramar Beach, FL 32550
Phone (850) 654-3376

4400 E Highway 20
Ste 410
Niceville, FL 32578
Phone (850) 897-2000

Practitioners & affiliated clinicians

Practitioners 26

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.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1277337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303344000000",
    "number": "1114238193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12469 EMERALD COAST PKWY W",
            "address_2": "SUITE 101",
            "city": "MIRAMAR BEACH",
            "state": "FL",
            "postal_code": "325508305",
            "telephone_number": "850-654-3376",
            "fax_number": "850-654-3320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12469 EMERALD COAST PKWY W",
            "address_2": "SUITE 101",
            "city": "MIRAMAR BEACH",
            "state": "FL",
            "postal_code": "325508305",
            "telephone_number": "850-654-3376",
            "fax_number": "850-654-3320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL SKIN SURGERY AND DERMATOLOGY, PL",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-24",
        "last_updated": "2011-04-21",
        "status": "A",
        "authorized_official_last_name": "ADAMS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER, PRESIDENT",
        "authorized_official_telephone_number": "850-654-3376",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "FL",
            "license": "ME92098",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSFL",
            "identifier": "00175",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Miramar Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2011; 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.